Health Disparities in Asthma

Forno, Erick; Celedón, Juan C.

doi:10.1164/rccm.201202-0350ed

Cited by 113 publications

(67 citation statements)

References 17 publications

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“…Not only is this population under-represented in clinical investigations, but this population also is known to have a disparate risk of asthma and atopic disease. 16 Several limitations in this study also should be acknowledged. First, the smoking prevalence was determined by parent reporting, which likely underestimates the true prevalence, because children may have significant exposure outside the home environment.…”

Section: Discussionmentioning

confidence: 92%

Association of tobacco smoke exposure and atopic sensitization

Ciaccio

DiDonna

Kennedy

et al. 2013

Annals of Allergy, Asthma & Immunology

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Background Forty million children are regularly exposed to environmental tobacco smoke (ETS) each year, increasing their risk for premature death and middle ear and acute respiratory infections. Early life exposure to ETS also is clearly associated with wheezing. However, there is no clear understanding of the influence of ETS on the development of allergic sensitization. Objective To determine the association of combined exposure to ETS and indoor allergens on IgE sensitization to aeroallergens in children. Methods This case–control study enrolled 116 cases and 121 controls from low-income families from Kansas City, Missouri. The adjusted odds ratio was calculated using a logistic model to assess the association between ETS and allergic sensitization using dust allergen levels as a covariate. Results Thirty-six percent of atopic children and 39% of controls were exposed to ETS (P < .05). Unadjusted analyses showed no significant influence of ETS on IgE sensitization to indoor allergens. Logistic regression analyses also showed no significant influence of ETS on sensitization when adjusted for levels of allergens in the home dust and family history of allergic rhinitis. Conclusion These data suggest that ETS exposure was not associated with IgE sensitization to indoor allergens, even when home allergen levels were taken into consideration. Further understanding of how components of tobacco smoke influence the immune response is necessary to interpret the disparate findings across studies.

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Section: Discussionmentioning

confidence: 92%

Association of tobacco smoke exposure and atopic sensitization

Ciaccio

DiDonna

Kennedy

et al. 2013

Annals of Allergy, Asthma & Immunology

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“…Asthma prevalence and exacerbation disparities by race/ethnicity and socioeconomic status are also a well-known problem in the US [5–7]. Factors contributing to them include non-modifiable factors such as differences in genetic ancestry [8–10], and modifiable factors such as poor health, disease risk factors, medication non-adherence, health literacy and limited access to health care due to social, economic and environmental disadvantages [6, 11, 12].…”

Section: Introductionmentioning

confidence: 99%

Gender-specific determinants of asthma among U.S. adults

Greenblatt

Mansour

Zhao

et al. 2017

asthma res and pract

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BackgroundAsthma, a chronic respiratory disease affecting over 18.7 million American adults, has marked disparities by gender, race/ethnicity and socioeconomic status. Our goal was to identify gender-specific demographic and socioeconomic determinants of asthma prevalence among U.S. adults using data from the Behavioral Risk Factors Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey (NHANES).MethodsGender-specific regression analyses were performed to model the relationship between asthma prevalence with age, race/ethnicity, income, education level, smoking status, and body mass index (BMI), while taking into account the study designs.ResultsBased on BRFSS data from 1,003,894 respondents, weighted asthma prevalence was 6.2% in males and 10.6% in females. Asthma prevalence among grade 2 obese and grade 3 obese vs. not overweight or obese women was 2.5 and 3.5 times higher, respectively, while that in men was 1.7 and 2.4 times higher; asthma prevalence among current vs. never smoker women was 1.4 times higher, while that in men was 1.1 times higher. Similar results were obtained with NHANES data from 13,364 respondents: asthma prevalence among grade 2 obese and grade 3 obese vs. not overweight or obese respondents was 2.0 and 3.3 times higher for women, though there was no significant difference for men; asthma prevalence among current vs. never smokers was 1.8 times higher for women and not significantly different in men. Asthma prevalence by race/ethnicity and income levels did not differ considerably between men and women.ConclusionsOur results underscore the importance of obesity and smoking as modifiable asthma risk factors that most strongly affect women.Electronic supplementary materialThe online version of this article (doi:10.1186/s40733-017-0030-5) contains supplementary material, which is available to authorized users.

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“…There are significant racial-ethnic differences in asthma prevalence and severity of illness [3–5]. According to Smith et al, genetic susceptibility in combination with psychosocial factors, socioeconomic status, environmental exposures, and access to medical care all play contributing roles [6].…”

Section: Introductionmentioning

confidence: 99%

Individual and county level predictors of asthma related emergency department visits among children on Medicaid: A multilevel approach

Baltrus

Immergluck

et al. 2016

Journal of Asthma

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Objective: Disparities in asthma outcomes are well documented in the United States. Interventions to promote equity in asthma outcomes could target factors at the individual and community levels. The objective of this analysis was to understand the effect of individual (race, gender, age, and preventive inhaler use) and county-level factors (demographic, socioeconomic, health care, air-quality) on asthma emergency department (ED) visits among Medicaid-enrolled children. This was a retrospective cohort study of Medicaid-enrolled children with asthma in 29 states in 2009. Multilevel regression models of asthma ED visits were constructed utilizing individual-level variables (race, gender, age, and preventive inhaler use) from the Medicaid enrollment file and county-level variables reflecting population and health system characteristics from the Area Resource File (ARF). County-level measures of air quality were obtained from Environmental Protection Agency (EPA) data. Results: The primary modifiable risk factor at the individual level was found to be the ratio of long-term controller medications to total asthma medications. County-level factors accounted for roughly 6% of the variance in the asthma ED visit risk. Increasing county-level racial segregation (OR=1.04, 95% CI=1.01-1.08) was associated with increasing risk of asthma ED visits. Greater supply of pulmonary physicians at the county level (OR=0.81, 95% CI=0.68-0.97) was associated with a reduction in risk of asthma ED visits. Conclusions: At the patient care level, proper use of controller medications is the factor most amenable to intervention. There is also a societal imperative to address negative social determinants, such as residential segregation.

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Health Disparities in Asthma

Cited by 113 publications

References 17 publications

Association of tobacco smoke exposure and atopic sensitization

Association of tobacco smoke exposure and atopic sensitization

Gender-specific determinants of asthma among U.S. adults

Individual and county level predictors of asthma related emergency department visits among children on Medicaid: A multilevel approach

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