Research Challenges Asthma and Inner-City Link

Writing online in January, 2015, in the Journal of Allergy and Clinical Immunology, researchers “sought to estimate the prevalence of current asthma in US children living in inner-city and non–inner-city areas and to examine whether urban residence, poverty, or race/ethnicity are the main drivers of asthma disparities. The National Health Interview Survey 2009-2011 was linked by census tract to data from the US Census and the National Center for Health Statistics. Multivariate logistic regression models adjusted for sex; age; race/ethnicity; residence in an urban, suburban, medium metro, or small metro/rural area; poverty; and birth outside the United States, with current asthma and asthma morbidity as outcome variables.”

The authors “included 23,065 children living in 5,853 census tracts. The prevalence of current asthma was 12.9% in inner-city and 10.6% in non–inner-city areas, but this difference was not significant after adjusting for race/ethnicity, region, age, and sex. In fully adjusted models black race, Puerto Rican ethnicity, and lower household income but not residence in poor or urban areas were independent risk factors for current asthma. Household poverty increased the risk of asthma among non-Hispanics and Puerto Ricans but not among other Hispanics. Associations with asthma morbidity were very similar to those with prevalent asthma.” The researchers conclude that “although the prevalence of asthma is high in some inner-city areas, this is largely explained by demographic factors and not by living in an urban neighborhood.”

In a separate statement released by John Hopkins University, lead investigator Dr. Corinne Keet noted that “’Our results highlight the changing face of pediatric asthma and suggest that living in an urban area is, by itself, not a risk factor for asthma….Instead, we see that poverty and being African American or Puerto Rican are the most potent predictors of asthma risk.’ The idea that certain aspects of urban living—pollution, cockroach and other pest allergens, higher rates of premature births, exposure to indoor smoke— make inner-city children more prone to developing asthma emerged more than 50 years ago, when public health experts first described an epidemic of inner-city asthma cases. While all those factors continue to fuel asthma risk, the investigators say, they may no longer be exclusive to or even predominant in inner-city areas, and the new study findings bear out this phenomenon.

The results, the researchers say, reflect powerful demographic shifts at work, such as increasing poverty in suburban and rural areas, and the movement of racial and ethnic minorities out of inner cities. Therefore, they add, public health interventions should also reflect this changing reality.

The abstract and statement are available online.

 

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