Relationships of Race and Socioeconomic Status with Prevalence, Severity, and Symptoms of Asthma in Chicago School Children

Persky, Victoria; Slezak, Julie; Contreras, Alicia; Becker, Laura; Hernández, Elena; Ramakrishnan, Viswanathan; Piorkowski, Julie

doi:10.1016/s1081-1206(10)62824-4

Cited by 133 publications

(70 citation statements)

References 18 publications

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“…Although low SES independently and powerfully predicts poor asthma management and outcome, 4,5,7,13,16,23,24,28,36,37 only a few studies have shown that SES differences account for most or all of the race/ethnicity-based differences in asthma. 1,8,14,27,28 Many others have demonstrated that, even after controlling for factors such as income and insurance status, black and Hispanic children still have higher prevalence, 3,6,18,25 have more severe asthma symptoms, 12,19,22 visit the ED more often, 12,15,18 are hospitalized more frequently, 5,15,23 receive suboptimal preventive therapy, 4,11,15 and have greater mortality rates. 37 On the basis of these studies, the SES hypothesis seems inadequate to explain fully the racial/ethnic difference in asthma among children.…”

Section: Role Of Sesmentioning

confidence: 99%

Race/Ethnicity and Asthma Among Children Presenting to the Emergency Department: Differences in Disease Severity and Management

et al. 2003

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ABSTRACT. Objective. To investigate racial/ethnic differences in acute asthma among children who present to the emergency department (ED).Method. We analyzed data from 2 prospective cohort studies performed during 1997-1998 as part of the Multicenter Airway Research Collaboration. Using a standardized protocol, researchers at 40 EDs in 18 US states provided 24-hour-per-day coverage for a median of 2 weeks per year. Children with acute asthma were interviewed in the ED and by telephone 2 weeks after discharge.Results. Among 1095 patients, 679 (62%) were black, 256 (23%) were Hispanic, and 160 (15%) were white. Black and Hispanic children had greater histories of lifetime (63%, 64%, 46%) and past-year (34%, 31%, 14%) hospitalization and more ED visits in the past year (medians: 2, 3, 1). Asthma severity at ED presentation, ED management and course, hospitalization during the index visit, discharge prescriptions, and postdischarge outcomes were equivalent among all race/ethnic groups.Conclusion. Despite pronounced race/ethnicity-based differences in chronic asthma, all racial/ethnic groups exhibited similar acute asthma severity, ED management, and course. However, given that black and Hispanic children exhibited much higher admission histories and past ED use, the equivalence in inhaled corticosteroid prescriptions on discharge is a disconcerting pattern that mirrors previous literature on outpatient prescription practices. In addition to barriers attributable to socioeconomic factors, health care providers and policy makers should target equalizing deficiencies in preventive medication prescription practices. Pediatrics 2003;111:e615-e621. URL: http://www.pediatrics.org/cgi/content/full/111/5/e615; asthma, children, socioeconomic status, race, ethnicity, quality of care.ABBREVIATIONS. ED, emergency department; MARC, Multicenter Airway Research Collaboration; PCP, primary care provider; SES, socioeconomic status. D espite effective therapies, asthma prevalence, morbidity, and mortality among children is increasing in the United States, and the burden is being borne disproportionately by blacks and Hispanics. Previous studies have focused primarily on racial/ethnic disparities noted in chronic care and management and have relied heavily on archival or billing data. To examine further the role of race/ ethnicity on asthma among children who present to the emergency department (ED), we examined prospective data from the Multicenter Airway Research Collaboration (MARC). On the basis of previous research, we hypothesized that black and Hispanic children with asthma would 1) exhibit more severe respiratory distress on arrival to the ED, 2) receive less adequate care while in the ED, 3) be admitted more often from the ED during their index visit, and 4) be more likely to relapse or have continued symptoms during the 2 weeks postdischarge. We further hypothesized that sociodemographic factors (including parental education, income, and insurance status) and access to a primary care provider (PCP) would play an important r...

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Section: Role Of Sesmentioning

confidence: 99%

Race/Ethnicity and Asthma Among Children Presenting to the Emergency Department: Differences in Disease Severity and Management

et al. 2003

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“…1,2 Chicago's asthma prevalence and morbidity and mortality rates are among the highest in the nation, and within the city, they are typically highest in neighborhoods with the lowest SES. [3][4][5][6][7][8] Chicago's burden, and the national epidemic, are not well-explained by known risk factors. Not all urban communities have excess asthma prevalence and morbidity though they may share low-SES and environmental exposures with high-risk urban areas.…”

Section: Introductionmentioning

confidence: 99%

Stress and the City: Housing Stressors are Associated with Respiratory Health among Low Socioeconomic Status Chicago Children

et al. 2010

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Asthma disproportionately affects non-whites in urban areas and those of low socioeconomic status, yet asthma's social patterning is not well-explained by known risk factors. We hypothesized that disadvantaged urban populations experience acute and chronic housing stressors which produce psychological stress and impact health through biological and behavioral pathways. We examined eight outcomes: six child respiratory outcomes as well as parent and child general health, using data from 682 low-income, Chicago parents of diagnosed and undiagnosed asthmatic children. We created a continuous exposure, representing material, social and emotional dimensions of housing stressors, weighted by their parent-reported difficulty. We compared the 75th to the 25th quartile of exposure in adjusted binomial and negative binomial regression models. Higher risks and rates of poor health were associated with higher housing stressors for six of eight outcomes. The risk difference (RD) for poor/fair general health was larger for children [RD=6.28 (95% CI 1.22, 11.35)] than for parents [RD=3.88 (95% CI −1.87, 9.63)]. The incidence rate difference (IRD) for exercise intolerance was nearly one extra day per 2 weeks for the higher exposure group [IRD= 0.88 (95% CI 0.41, 1.35)]; nearly one-third extra day per 2 weeks for waking at night [IRD=0.32 (95% CI 0.01, 0.63)]; and nearly one-third extra day per 6 months for unplanned medical visits [IRD=0.30 (95% CI 0.059, 0.54)]. Results contribute to the conceptualization of urban stress as a "social pollutant" and to the hypothesized role of stress in health disparities. Interventions to improve asthma outcomes must address individuals' reactions to stress while we seek structural solutions to residential stressors and health inequities.

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“…2 Thousands of additional HUD units will be demolished, within and outside of the HOPE VI program. The demolition of public housing structures typically occurs in minority, lowincome, urban communities, which, in Chicago, IL, tend to have higher prevalence rates of asthma 3 and more severe asthma than the general population. 4,5 A study conducted in public housing developments slated for HOPE VI demolition estimated that 25% of children Ͻ6 years of age have asthma, and one in eight children of all ages have had an emergency department visit for asthma in the preceding 12 months.…”

Section: Introductionmentioning

confidence: 99%

“…; (2) what is the size of particles generated at sites of public housing demolition? ; (3) what are the temporal characteristics of local PM concentrations during demolition (i.e., do short-term peaks in particulate concentrations occur)? ; (4) what activities at a site of structural demolition are associated with changes in real-time particulate measures?…”

Section: Introductionmentioning

confidence: 99%

Demolition of High-Rise Public Housing Increases Particulate Matter Air Pollution in Communities of High-Risk Asthmatics

Dorevitch

Demirtaş

Perksy

et al. 2006

Journal of the Air & Waste Management Association

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Public housing developments across the United States are being demolished, potentially increasing local concentrations of particulate matter (PM) in communities with high burdens of severe asthma. Little is known about the impact of demolition on local air quality. At three public housing developments in Chicago, IL, PM with an aerodynamic diameter Ͻ10 m (PM 10 ) and Ͻ2.5 m were measured before and during high-rise demolition. Additionally, size-selective sampling and real-time monitoring were concurrently performed upwind and downwind of one demolition site. The concentration of particulates attributable to demolition was estimated after accounting for background urban air pollution. Particle microscopy was performed on a small number of samples. Substantial increases of PM 10 occurred during demolition, with the magnitude of that increase varying based on sampler distance, wind direction, and averaging time. During structural demolition, local concentrations of PM 10 42 m downwind of a demolition site increased 4-to 9-fold above upwind concentrations (6-hr averaging time). After adjusting for background PM 10 , the presence of dusty conditions was associated with a 74% increase in PM 10 100 m downwind of demolition sites (24-hr averaging times). During structural demolition, short-term peaks in real-time PM 10 (30-sec averaging time) occasionally exceeded 500 g/m 3 . The median particle size downwind of a demolition site (17.3 m) was significantly larger than background (3 m). Specific activities are associated with realtime particulate measures. Microscopy did not identify asbestos or high concentrations of mold spores. In conclusion, individuals living near sites of public housing demolition are at risk for exposure to high particulate concentrations. This increase is characterized by relatively large particles and high short-term peaks in PM concentration.

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Relationships of Race and Socioeconomic Status with Prevalence, Severity, and Symptoms of Asthma in Chicago School Children

Cited by 133 publications

References 18 publications

Race/Ethnicity and Asthma Among Children Presenting to the Emergency Department: Differences in Disease Severity and Management

Race/Ethnicity and Asthma Among Children Presenting to the Emergency Department: Differences in Disease Severity and Management

Stress and the City: Housing Stressors are Associated with Respiratory Health among Low Socioeconomic Status Chicago Children

Demolition of High-Rise Public Housing Increases Particulate Matter Air Pollution in Communities of High-Risk Asthmatics

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