Asthma Race and Income Problem, Not Inner City One


Public health officials have long believed that pollution and overcrowding have fueled what they believed to be an epidemic of asthma in inner cities. However, a new study shows that respiratory disease is actually more of a race and income problem, and not an inner city issue. In fact, medium-sized cities in some areas have more asthmatics than dense city centers nearby.

The Journal of Allergy and Clinical Immunology recently published a study chronicling research that compared childhood asthma rates by U.S. census data tracts. The researchers, who were from Johns Hopkins University, determined that children in inner-city areas were not more susceptible to breathing problems than children living elsewhere.

The research team used data gathered in the National Health Interview Survey (NHIS) to compare the asthma prevalence in large urban areas versus the rate in rural or suburban areas. The survey is a research tool of the U.S. Centers for Disease Control and Prevention (CDC) that looks at illness, medical care, diet and other key aspects of life throughout America. It contains questions about any asthma diagnosis or attacks in the last 12 months or attacks that required a visit to an emergency room. For the purposes of their study, the Johns Hopkins research team focused on the information gathered on more than 23,000 children who were ages 6 through 17 from 2009 to 2011.

On a first broad stroke review, the data showed that nearly 13 percent of inner-city kids had the lung disease, contrasted with the almost 11 percent of kids who resided elsewhere. On further review, the differences between asthma rates was statistically insignificant, particularly after the data was separated by ethnicity, age, gender as well as geographic part of the U.S., debunking popular beliefs.

Overall, the study showed three factors that created higher risk of a recent asthma attack or ER visit: Being African American, Puerto Rican or from a low-income household. Type of neighborhood did not matter as much as geographical region.

The researchers found that asthma’s pervasiveness within urban areas varied widely by part of the nation. In the West, they found that 7.9 percent of children in the inner city had the respiratory disease. However, in the Northeast the rate jumped to 17.3 percent. Likewise, asthma rates were higher in mid-sized cities and suburban sections in the Northeast.

They determined that a bigger differentiator than residential environment was the child’s race, ethnicity and socioeconomic situation. At 19.8 percent, children of Puerto Rican descent had the highest asthma rate for any ethnic group. African American kids were second with 17.1 percent. Conversely, children who were Asian American, non-Puerto Rican Latinos or white had much lower rates (8.1, 8.8 and 9.6 percent, respectively).

Poverty in any neighborhood or ethnic family also impacted asthma rates. Poor areas tend to have more indoor allergens that affect breathing, such as rodents, cockroaches, cigarette smoke and diesel exhaust. The poor also generally have worse diets and more stress, which can also affect pulmonary health.

People living in poor urban areas may be particularly susceptible to this breathing problem for a variety of environmental and cultural reasons. Indoor allergens from rodents and cockroaches can trigger an attack, as can pollutants like cigarette smoke and particles from diesel exhaust. Being poor is also associated with worse diets, more stress and less breast-feeding – all risk factors for developing the lung disease.

Asthma is a lung disease that affects over 25 million Americans, including an estimated 7 million children. However, as the study showed, those children are more likely to have a breathing problem because of race, household income and section of the U.S., not based on being an inner city child or suburban one.

By Dyanne Weiss

Journal of Allergy and Clinical Immunology
Los Angeles Times
Science World Report

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