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

Abstract

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.

Socio-economic determinants of asthma and allergic diseases among students of lower secondary schools in Bytom

“…These results are consistent with observations made by other authors. Most studies point out that children whose families are characterized by a low SES have respiratory system symptoms more frequently than bronchial asthma itself [7,14,15]. Unfortunately, the design of our study does not allow for more detailed explanation of the differences between SES and the incidence of respiratory disease.…”

“…Probably, it is implied by different definitions of SES and its various research areas which are taken into account in studies. Some papers indicate that a high percentage of children with asthma come from families with a low SES, while others do not find relationships between SES and the incidence of asthma and allergy [6,7]. In the study by Poyser et al it was found that asthma is a disease of affluent individuals, while Hancox et al did not observe any relationship between parents' income and the incidence of asthma in a group of 13-and 15-year-olds [8,9].…”

Prevalência e fatores de risco para asma em adolescentes de 13 a 14 anos do Município de Cuiabá, Mato Grosso, Brasil

“…As diferenças de prevalência da asma quando considerados diferentes níveis socioeconômi-cos mostram resultados controversos 28,29 . No Brasil, alguns estudos encontraram prevalência de asma maior em adolescentes de baixo nível socioeconômico 30,31 .…”

Factors Related to Undiagnosed Asthma in Urban Adolescents: A Multilevel Approach

“…Shankardass et al (2007) found that census-derived estimates of community-level socioeconomic status, including male unemployment, household income, low educational attainment, and poverty, were consistently inversely associated with prevalent childhood asthma controlling for individual level measures of social economic status (SES) [36]. Using health care utilization records and census tract demographic data from Alameda County, CA, Roberts et al (2008) observed that high poverty communities tended to have higher rates of outpatient emergency care for asthma, as well as lower rates of indicators for quality primary care for asthma [37].…”