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Inner-city residence linked to pediatric asthma morbidity, not prevalence
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Although asthma morbidity is associated with living in poor and urban areas, these risk factors are not connected to prevalence of the condition in children from low-income families.
“Since at least the 1960s, researchers have identified poor-urban areas — the ‘inner city’ — as hotspots of high asthma prevalence and morbidity,” Corrine A. Keet, MD, PhD, associate professor at John Hopkins University School of Medicine, and colleagues wrote. “However, until recently, there [were] very little data on the national scale to confirm that inner-city residence is in fact associated with either a prevalence of asthma or, among those with asthma, greater asthma morbidity.”
The researchers analyzed the connection between race and ethnicity, residing in inner-city locations and asthma morbidity in asthmatic children enrolled in Medicaid, specifically those aged 5 to19 years and who were enrolled in the program between 2009 and 2010. For a child to be considered asthmatic, he or she must have had at least one outpatient or emergency department visit over the 2-year period. Additionally, a primary diagnosis code of asthma must have been applied.
Once data were collected on included children, researchers used logistic models to observe the effects of socioeconomic, geographic and racial/ethnic factors on outpatient and ED visits, as well as hospitalizations.
Among children enrolled in Medicaid between 2009 and 2010 (16,860,716), 1,534,820 were considered asthmatic. For these children, inner-city residence did not correlate with an increased risk in asthma prevalence in crude or adjusted analyses. However, residency in inner cities did demonstrate more asthma-related ED visits and hospitalizations when using crude analyses and when adjusted for age, race/ethnicity and gender.
Additionally, those who were non-Hispanic black and resided within urban or poor areas exhibited an increased risk of asthma-related ED visits and hospitalizations.
“It is very likely that no one exposure accounts for the increased asthma morbidity associated with living in poor or urban areas. Researchers studying asthma in the inner city have established that exposure to common household pests that are more common in poor and urban areas, such as cockroaches and mice, is associated with worse asthma control,” Keet and colleagues wrote. “Air pollution, which may act synergistically with allergen exposures, is another likely contributor to increased morbidity in poor and urban areas. [Urban areas tend to be] closer to stationary sources of air pollution … and thus have higher levels of pollutants associated with asthma morbidity, such as particulate matter, nitric oxides and ozone.” — by Katherine Bortz
Disclosure: The researchers report no relevant financial disclosures.
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