Poverty, race, and hospitalization for childhood asthma.

Wissow, Lawrence S.; Gittelsohn, Alan M.; Szklo, Moysés; Starfield, Bárbara; Mussman, M

doi:10.2105/ajph.78.7.777

Cited by 337 publications

(127 citation statements)

References 17 publications

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“…Characteristics of interest at the community level have previously been suggested as measures of SEP that were associated with health effects (Haan, Kaplan, & Camacho, 1987;Jin, Shah, & Svaboda, 1994;Juhn, Sauver, Katusic et al, 2005;Wissow, Gittelsohn, Szklo, Starfield, & Mussman, 1988). They included community measures of median household income, proportion of respondents with low education (i.e.…”

Section: Community Socioeconomic Variablesmentioning

confidence: 99%

The association between contextual socioeconomic factors and prevalent asthma in a cohort of Southern California school children

Shankardass

McConnell

Milam

et al. 2007

Social Science & Medicine

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Spatial variation in childhood asthma and a recent increase in prevalence indicate that environmental factors play a significant role in the etiology of this important disease. Socioeconomic position (SEP) has been associated inversely and positively with childhood asthma. These contradictory results indicate a need for systematic research about SEP and asthma. Pathways have been suggested for effects of SEP on asthma at both the individual and community level. We examined the relationship of prevalent asthma to community-level indicators of SEP among 5762 children in 12 Southern California, using a multilevel random effects model. Estimates of community-level SEP were derived by summarizing census block group-level data using a novel method of weighting by the proportion of the block groups included in a community-specific bounding rectangle that contained 95% of local study subjects. Community © 2007 Elsevier Ltd. All rights reserved.Corresponding Author: shankard@usc.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript characteristics included measures of male unemployment, household income, low education (i.e. no high school diploma), and poverty. There was a consistent inverse association between male unemployment and asthma across the inter-quartile range of community unemployment rates, indicating that asthma rates increase as community SEP increases. The results were robust to individual-level confounding, methods for summarizing census block group data to the community level, scale of analysis (i.e. community-level vs. neighborhood-level) and the modeling algorithm. The positive association between SEP and prevalent childhood asthma might be explained by differential access to medical care that remains unmeasured, by the hygiene hypothesis (e.g. lower SES may associate with higher protective exposures to endotoxin in early life), or by SEP acting as a proxy for unmeasured neighborhood characteristics.

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Section: Community Socioeconomic Variablesmentioning

confidence: 99%

The association between contextual socioeconomic factors and prevalent asthma in a cohort of Southern California school children

Shankardass

McConnell

Milam

et al. 2007

Social Science & Medicine

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“…Despite this, asthma morbidity and mortality are disproportionately high and continue to increase among African Americans (49)(50)(51)(52). In 2002, African Americans had emergency department visit rates of 380%, hospitalization rates of 225%, and mortality rates of over 200% higher than non-Hispanic whites (CDC report, http://www.cdc.gov/nchs/products/pubs/pubd/ hestats/asthma/asthma.htm).…”

Section: African Americans and Disparities In Asthma And Allergic Dismentioning

confidence: 99%

African Americans with Asthma: Genetic Insights

Barnes

Grant²,

Hansel³

et al. 2007

Proceedings of the American Thoracic Society

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It has been well established that genetic factors strongly affect susceptibility to asthma and its associated traits. It is less clear to what extent genetic variation contributes to the ethnic disparities observed for asthma morbidity and mortality. Individuals of African descent with asthma have more severe asthma, higher IgE levels, a higher degree of steroid dependency, and more severe clinical symptoms than individuals of European descent with asthma but relatively few studies have focused on this particularly vulnerable ethnic group. Similar underrepresentation exists for other minorities, including Hispanics. In this review, a summary of linkage and association studies in populations of African descent is presented, and the role of linkage disequilibrium in the dissection of a complex trait such as asthma is discussed. Consideration for the impact of population stratification in recently admixed populations (i.e., European, African) is essential in genetic association studies focusing on African ancestry groups. With the most recent update on the International HapMap Project, efficient selection of haplotype tagging single nucleotide polymorphisms (htSNPs) for African Americans has accelerated and efficiency of htSNPs chosen from one population to represent other continental groups (e.g., African) has been demonstrated. Cutting-edge approaches, such as genomewide association studies, admixture mapping, and phylogenetic analyses, offer new opportunities for dissecting the genetic basis for asthma in populations of African descent.

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“…A poor indoor environment aggravates asthma in children and poses a barrier to achieving asthma control. Thus, the Canadian Pediatric Asthma Consensus guidelines and the U.S. National Asthma Education and Prevention Program guidelines recommend strategies to manage asthma, including identifying allergens and engaging in behavior to reduce exposures in sensitized children (Becker et al, 2005 Asthma prevalence is higher among children from low-income families (Crain et al, 1994;Evans, 1992;Halfon & Newacheck, 1993;Weitzman, Gortmaker, & Sobol, 1990;Wissow, Gittelsohn, Szklo, Starfield, & Mussman, 1988) and is often more severe (Erzen et al, 1997;Mielck, Reitmeir, & Wjst, 1996). Among U.S. inner-city children, the most common risk factors for asthma morbidity were household environmental exposures (Krieger, Song, Takaro, & Stout, 2000;Warman, Silver, & Wood, 2006).…”

Section: Introductionmentioning

confidence: 99%