Pediatric Asthma Health Disparities: Race, Hardship, Housing, and Asthma in a National Survey

Abstract

Objectives We sought to determine if racial disparities in pediatric asthma are explained by material hardship and home ownership. Methods We performed a secondary analysis of the 2011 American Housing Survey. 33,201 households with children age 6-17 years were surveyed regarding childhood asthma diagnosis and ED visits for asthma (for the youngest child with asthma in the household). Material hardship included poor housing quality, housing crowding, lack of amenities, and no vehicle access. We used logistic regression to determine the association between race, material hardship, and asthma diagnosis or ED visits, adjusting for potential confounders. Results Non-Hispanic Black heads of household had a higher odds of having a child diagnosed with asthma in the home in comparison to non-Hispanic White heads of household (OR 1.72, 95%CI 1.50-1.96), and a higher odds of ED visits for asthma (OR 3.02, 95%CI 2.29-3.99). The race-asthma association was decreased but not eliminated after adjusting for material hardship and home ownership (ED Visit AOR 2.07, 95%CI 1.50-2.86). Poor housing quality was independently associated with asthma diagnosis (AOR 1.45, 95%CI 1.28-1.66) and ED visits (AOR 1.59, 95%CI 1.21-2.10). Home ownership was associated with a lower odds of asthma-related ED visits (AOR 0.62, 95% CI 0.46-0.84). Conclusions Observed racial disparities in pediatric asthma are lessened after controlling for material hardship. Poor housing quality in particular is strongly associated with asthma morbidity. Policy makers could target improving housing quality as a means of potentially reducing asthma disparities.

The “envirome” and what the practitioner needs to know about it

“…Although housing stress was explored as a cofactor for asthma in this study, poor housing in general may be a risk factor for asthma morbidity. Supporting this idea are observations by Hughes et al, 55 who examined housing quality and home ownership as independent factors in asthma morbidity in a secondary analysis of data from the 2011 American Housing Survey of 33,201 households with children age 6 to 17 years. They reported that poor housing quality increased risk for asthma diagnosis (OR ¼ 1.45), ED visits for asthma (ED ¼ 1.59), and home ownership decreased risk for asthma-related ED visits (OR ¼ 0.62).…”

Characterization of Stress in Low-Income, Inner-City Mothers of Children with Poorly Controlled Asthma

“…In fact, home rodent infestation was one of the most commonly reported negative life events, comparable to rates observed in a sample of urban Puerto Rican families of children with asthma [43]. Addressing poor housing stock is particularly critical since, beyond its relationship with elevated caregiver life stress, environmental exposures stemming from sub-standard housing were associated with higher rates of ED visits in children with asthma aged 6-17 years [44]. Recommendations to improve the quality of housing stock include implementing healthy housing guidelines for new construction, increased enforcement of housing codes, and home visiting education and environmental intervention programs to reduce trigger exposures [45].…”

Managing Asthma in Low-Income, Underrepresented Minority, and Other Disadvantaged Pediatric Populations: Closing the Gap

“…Material hardship and home ownership were recently examined as a contributor to disparities by Hughes et al [25••]. They analyzed the 2011 American Housing Survey and found that poor housing quality was associated with asthma diagnosis and emergency department visits.…”