Published online: May 18, 2018
Children living in poor-urban areas may have worse asthma than children living elsewhere. They may have more difficult to control symptoms and more asthma attacks. This is very harmful and can last into adulthood. It is not well understood why children living in poor-urban neighborhoods have worse asthma. Some have suggested that it may reflect the characteristics of individuals who live in poor-urban neighborhoods rather than the actual characteristics of the poor-urban neighborhoods. This study examined the association between poor asthma control and living in poor-urban neighborhoods, after controlling for individual characteristics like race, ethnicity, and education.
Sullivan and colleagues recently published a study in The Journal of Allergy and Clinical Immunology: In Practice that included children aged 1-17 in the 2000-2014 Medical Expenditure Panel Survey (MEPS), a nationally representative sample of individuals in the U.S. The authors compared asthma control for children who live in poor-urban areas compared to children who live elsewhere. Indicators of poor asthma control included over-use of rescue inhalers, asthma attacks, Emergency Department visits, or hospitalizations. The authors also compared the use of controller medications to rescue medications for children in poor-urban neighborhoods. Higher use of rescue medications with lower use of controller medications is considered to be an indication of poor asthma control.
There were 15,052 children in this study, representing 8.4 million children with asthma in the U.S. in 2014. Children with asthma who lived in poor-urban neighborhoods were less likely to use controller medications and used relatively more rescue medications than controller medications. Children with asthma who lived in poor-urban neighborhoods were also more likely to visit the Emergency Room or go to the hospital for their asthma. Black race and Hispanic ethnicity were also associated with over-use of rescue medications and Emergency Room visits and hospitalizations for asthma.
Children who live in poor-urban neighborhoods may have a higher likelihood of having poorly controlled asthma even after controlling for individual characteristics like race and ethnicity. Future research is needed to better understand why asthma control is worse for children who live in poor-urban neighborhoods.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
Health Disparities among Children with Asthma in the U.S. by Place of Residence
By Patrick W. Sullivan, Vahram Ghushchyan, Abhishek Kavati, Prakash Navaratnam, Howard S. Friedman, B. Ortiz