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Pediatric Asthma Health Disparities: Race, Hardship, Housing, and Asthma in a National Survey

Published:November 19, 2016DOI:https://doi.org/10.1016/j.acap.2016.11.011

      Abstract

      Objective

      We sought to determine if racial disparities in pediatric asthma are explained by material hardship and home ownership.

      Methods

      We performed a secondary analysis of the 2011 American Housing Survey. A total of 33,201 households with children age 6 to 17 years were surveyed regarding childhood asthma diagnosis and emergency department (ED) visits for asthma (for the youngest child with asthma in the household). Material hardship included poor housing quality, housing crowding, lack of amenities, and no vehicle access. We used logistic regression to determine the association between race, material hardship, and asthma diagnosis or ED visits, adjusting for potential confounders.

      Results

      Non-Hispanic black heads of household had a higher odds of having a child diagnosed with asthma in the home compared with non-Hispanic white heads of household (odds ratio, 1.72; 95% confidence interval [CI], 1.50–1.96), and a higher odds of ED visits for asthma (odds ratio, 3.02; 95% CI, 2.29–3.99). The race–asthma association was decreased but not eliminated after adjusting for material hardship and home ownership (ED visit adjusted odds ratio [AOR], 2.07; 95% CI, 1.50–2.86). Poor housing quality was independently associated with asthma diagnosis (AOR, 1.45; 95% CI, 1.28–1.66) and ED visits (AOR, 1.59; 95% CI, 1.21–2.10). Home ownership was associated with a lower odds of asthma-related ED visits (AOR, 0.62; 95% CI, 0.46–0.84).

      Conclusions

      Observed racial disparities in pediatric asthma are lessened after controlling for material hardship. Poor housing quality in particular is strongly associated with asthma morbidity. Policy makers could target improving housing quality as a means of potentially reducing asthma disparities.

      Keywords

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      References

        • Hill T.D.
        • Graham L.M.
        • Divgi V.
        Racial disparities in pediatric asthma: a review of the literature.
        Curr Allergy Asthma Rep. 2011; 11: 85-90
      1. National Institutes of Health. Department of Health and Human Services. National Asthma Control Initiative. Reducing asthma disparities. Available at: http://www.nhlbi.nih.gov/health-pro/resources/lung/naci/discover/disparities.htm. Accessed March 1, 2016.

        • Akinbami L.J.
        • Moorman J.E.
        • Bailey C.
        • et al.
        Trends in asthma prevalence, healthcare use, and mortality in the United States, 2001-2010.
        in: NCHS data brief, no 94. National Center for Health Statistics, Hyattsville, MD2012
        • Akinbami L.J.
        • LaFleur B.J.
        • Schoendorf K.C.
        Racial and income disparities in childhood asthma in the United States.
        Ambul Pediatr. 2002; 2: 382-387
        • Canino G.
        • McQuaid E.L.
        • Rand C.S.
        Addressing asthma health disparities: a multilevel challenge.
        J Allergy Clin Immunol. 2009; 123 (quiz 1218–1219): 1209-1217
        • Braveman P.A.
        • Cubbin C.
        • Egerter S.
        • et al.
        Socioeconomic status in health research: one size does not fit all.
        JAMA. 2005; 294: 2879-2888
        • Kaufman J.S.
        • Cooper R.S.
        • McGee D.L.
        Socioeconomic status and health in blacks and whites: the problem of residual confounding and the resiliency of race.
        Epidemiology. 1997; 8: 621-628
      2. Desilver D. Black incomes are up, but wealth isn't. Available at: http://www.pewresearch.org/fact-tank/2013/08/30/black-incomes-are-up-but-wealth-isnt. Accessed November 23, 2015.

      3. Ouellette T, Burstein N, Long D, et al. Measures of material hardship: final report. Available at: http://aspe.hhs.gov/hsp/material-hardship04/index.htm. Accessed March 1, 2016.

        • Beverly S.G.
        Material hardship in the United States: evidence from the Survey of Income and Program Participation.
        Soc Work Res. 2001; 25: 143-151
        • Krivo L.J.
        • Kaufman R.L.
        Housing and wealth inequality: racial-ethnic differences in home equity in the United States.
        Demography. 2004; 41: 585-605
        • Cubbin C.
        • Pollack C.
        • Flaherty B.
        • et al.
        Assessing alternative measures of wealth in health research.
        Am J Public Health. 2011; 101: 939-947
        • Pollack C.E.
        • Chideya S.
        • Cubbin C.
        • et al.
        Should health studies measure wealth?: A systematic review.
        Am J Prev Med. 2007; 33: 250-264
        • Frank D.A.
        • Casey P.H.
        • Black M.M.
        • et al.
        Cumulative hardship and wellness of low-income, young children: multisite surveillance study.
        Pediatrics. 2010; 125: e1115-e1123
        • Pollack C.E.
        • von dem Knesebeck O.
        • Siegrist J.
        Housing and health in Germany.
        J Epidemiol Community Health. 2004; 58: 216-222
        • Pollack C.E.
        • Griffin B.A.
        • Lynch J.
        Housing affordability and health among homeowners and renters.
        Am J Prev Med. 2010; 39: 515-521
        • Northridge J.
        • Ramirez O.F.
        • Stingone J.A.
        • et al.
        The role of housing type and housing quality in urban children with asthma.
        J Urban Health. 2010; 87: 211-224
        • Suglia S.F.
        • Duarte C.S.
        • Sandel M.T.
        • Wright R.J.
        Social and environmental stressors in the home and childhood asthma.
        J Epidemiol Community Health. 2010; 64: 636-642
        • Holt E.W.
        • Theall K.P.
        • Rabito F.A.
        Individual, housing, and neighborhood correlates of asthma among young urban children.
        J Urban Health. 2013; 90: 116-129
        • Wright R.J.
        • Subramanian S.V.
        Advancing a multilevel framework for epidemiologic research on asthma disparities.
        Chest. 2007; 132: 757S-769S
      4. US Department of Housing, and Urban Development. American housing survey for the United States: 2011. Available at: https://www.census.gov/content/dam/Census/programs-surveys/ahs/data/2011/h150-11.pdf. Accessed March 1, 2016.

      5. United States Census Bureau. American Housing Survey (AHS). AHS 2011 national summary report and tables. Available at: http://www.census.gov/programs-surveys/ahs/data/2011/ahs-2011-summary-tables/h150-11.html. Accessed March 22, 2016.

      6. US Department of Health & Human Services. ASPE. Office of The Assistant Secretary for Planning and Evaluation. Poverty guidelines. Available at: https://aspe.hhs.gov/poverty-guidelines. Published November 23, 2015. Accessed March 18, 2016.

        • StataCorp
        Stata Statistical Software: Release 11.
        StataCorp LP, College Station, TX2009
        • McDaniel M.
        • Paxson C.
        • Waldfogel J.
        Racial disparities in childhood asthma in the United States: evidence from the National Health Interview Survey, 1997 to 2003.
        Pediatrics. 2006; 117: e868-e877
        • Ash M.
        • Brandt S.
        Disparities in asthma hospitalization in Massachusetts.
        Am J Public Health. 2006; 96: 358-362
        • Lester L.A.
        • Rich S.S.
        • Blumenthal M.N.
        • et al.
        Ethnic differences in asthma and associated phenotypes: collaborative study on the genetics of asthma.
        J Allergy Clin Immunol. 2001; 108: 357-362
        • Xu J.
        • Meyers D.A.
        • Ober C.
        • et al.
        Genomewide screen and identification of gene-gene interactions for asthma-susceptibility loci in three U.S. populations: collaborative study on the genetics of asthma.
        Am J Hum Genet. 2001; 68: 1437-1446
        • Do D.P.
        • Frank R.
        • Finch B.K.
        Does SES explain more of the black/white health gap than we thought? Revisiting our approach toward understanding racial disparities in health.
        Soc Sci Med. 2012; 74: 1385-1393
        • Committee on Pediatric Research
        Race/ethnicity, gender, socioeconomic status—research exploring their effects on child health: a subject review.
        Pediatrics. 2000; 105: 1349-1351
        • Williams D.R.
        • Sternthal M.
        • Wright R.J.
        Social determinants: taking the social context of asthma seriously.
        Pediatrics. 2009; 123: S174-S184
        • Ahluwalia S.K.
        • Matsui E.C.
        The indoor environment and its effects on childhood asthma.
        Curr Opin Allergy Clin Immunol. 2011; 11: 137-143
        • Beck A.F.
        • Huang B.
        • Simmons J.M.
        • et al.
        Role of financial and social hardships in asthma racial disparities.
        Pediatrics. 2014; 133: 431-439
        • Krieger J.
        • Jacobs D.E.
        • Ashley P.J.
        • et al.
        Housing interventions and control of asthma-related indoor biologic agents: a review of the evidence.
        J Public Health Manag Pract. 2010; 16: S11-S20
        • Jacobs D.
        • Wilson J.
        • Dixon S.
        • et al.
        The relationship of housing and population health: a 30-year retrospective analysis.
        Environ Health Perspect. 2009; 117: 597-604
      7. United States Census Bureau. Wealth and asset ownership. Available at: http://www.census.gov/people/wealth/. Accessed December 1, 2015.

        • Rosenbaum E.
        Racial/ethnic differences in asthma prevalence: the role of housing and neighborhood environments.
        J Health Soc Behav. 2008; 49: 131-145