Role of Financial and Social Hardships in Asthma Racial Disparities

Beck, Andrew F.; Huang, Bin; Simmons, Jeffrey M.; Moncrief, Terri; Sauers, Hadley; Chen, Chen; Ryan, Patrick; Newman, Nicholas; Kahn, Robert S.

doi:10.1542/peds.2013-2437

Cited by 151 publications

(136 citation statements)

References 42 publications

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“…Patients were recruited and enrolled in the Greater Cincinnati Asthma Risks Study (GCARS) between August 2010 and October 2011 according to previously described procedures (6). Briefly, patients aged 1-16 years were identified during a hospitalization by the admitting physician's use of the evidence-based clinical pathway for acute asthma or bronchodilator-responsive wheezing.…”

Section: Methods Study Design and Populationmentioning

confidence: 99%

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Allergen Sensitization Profiles in a Population-Based Cohort of Children Hospitalized for Asthma

Beck¹,

Huang

Kercsmar

et al. 2015

Annals ATS

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Rationale: Allergen sensitization is associated with asthma morbidity. A better understanding of allergen sensitization patterns among children hospitalized for asthma could help clinicians tailor care more effectively. To our knowledge, however, sensitization profiles among children hospitalized for asthma are unknown.Objectives: We sought to describe allergen sensitization profiles and the distribution of self-reported in-home exposures among children hospitalized for asthma. We also sought to assess how sensitization profiles varied by sociodemographic and clinical factors.Methods: This population-based cohort study includes data for 478 children, aged 4-16 years, hospitalized for an asthma exacerbation. Predictors included child age, race, sex, insurance status, reported income, salivary cotinine, exposure to traffic-related air pollution, asthma and atopic history, and season of admission. Outcomes included serum IgE specific to Alternaria alternata/A. tenuis, Aspergillus fumigatus, American cockroach, mouse epithelium, dust mite (Dermatophagoides pteronyssinus and farinae), cat dander, and dog dander (deemed sensitive if IgE > 0.35). Self-reported adverse exposures included mold/mildew, water leaks, cockroaches, rodents, and cracks or holes in the walls or ceiling. Presence of carpeting and furry pets was also assessed.Measurements and Main Results: More than 50% of included patients were sensitized to each of Alternaria, Aspergillus, dust mite, cat dander, and dog dander; 28% were sensitized to cockroach and 18% to mouse. Roughly 68% were sensitized to three or more allergens with evidence of clustering. African American children, compared with white children, were more likely to be sensitized to Alternaria, Aspergillus, cockroach, and dust mite (all P , 0.01). White children were more likely to be sensitized to mouse, cat, and dog (all P , 0.01). Lower income was associated with cockroach sensitization whereas higher income was associated with dog and cat sensitization (all P , 0.01). Atopic history was associated with sensitization to three or more allergens (P , 0.01). Although 42% reported exposure to at least one adverse in-home exposure (and 72% to carpet, 51% to furry pets), only weak relationships were seen between reported exposures and sensitizations.Conclusions: Most children admitted to the hospital for asthma exacerbations are sensitized to multiple indoor allergens. Atopy on the inpatient unit serves as a potential target for improvement in chronic asthma management.

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Section: Methods Study Design and Populationmentioning

confidence: 99%

“…Asthma, a leading cause of childhood morbidity, disproportionately impacts children of minority race and low socioeconomic status (1)(2)(3)(4)(5)(6). One possible contributor to observed disparities is the link between asthma and the physical environment, mediated by allergen sensitization and exposure (7)(8)(9)(10)(11).…”

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confidence: 99%

Allergen Sensitization Profiles in a Population-Based Cohort of Children Hospitalized for Asthma

Beck¹,

Huang

Kercsmar

et al. 2015

Annals ATS

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“…We characterized hardship by using previously validated questions that were chosen a priori, and 11 survey questions were included. 23,[26][27][28] Specifically, financial hardship was assessed via questions relating to difficulty making ends meet, difficulty obtaining food, looking for work but being unable to find it, and having had to, for financial reasons, not pay rent or utilities, move in with others, pawn or sell possessions, or have creditors demand payment. A family's need to or inability to get help from others or borrow money during times of need was also assessed.…”

Section: Hardship Measuresmentioning

confidence: 99%

Family Hardships and Serum Cotinine in Children With Asthma

et al. 2015

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BACKGROUND AND OBJECTIVE: A better understanding of how poverty-related hardships affect child health could highlight remediable intervention targets. Tobacco smoke exposure may be 1 such consequence of family hardship. Our objective was to explore the relationship between family hardships and tobacco exposure, as measured by serum cotinine, a tobacco metabolite, among children hospitalized for asthma. METHODS:We prospectively enrolled a cohort of 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing. The primary outcome was detectable serum cotinine. We assessed family hardships, including 11 financial and social variables, through a survey of the child's caregiver. We used logistic regression to evaluate associations between family hardship and detectable cotinine. RESULTS:We had complete study data for 675 children; 57% were African American, and 74% were enrolled in Medicaid. In total, 56% of children had detectable cotinine. More than 80% of families reported $1 hardship, and 41% reported $4 hardships. Greater numbers of hardships were associated with greater odds of having detectable cotinine. Compared with children in families with no hardships, those in families with $4 hardships had 3.7-fold (95% confidence interval, 2.0-7.0) greater odds of having detectable serum cotinine in adjusted analyses. Lower parental income and educational attainment were also independently associated with detectable serum cotinine.

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“…[1][2][3] Asthma morbidity is especially common among those living with poverty and limited access. [4][5][6] Disparities are perpetuated by chronic underutilization of medications that can prevent asthma symptoms.…”

Section: What This Study Adds: a Newly Developedmentioning

confidence: 99%