Evalyn N. Grant

The Relation of Socioeconomic Factors and Racial/Ethnic Differences in US Asthma Mortality

OBJECTIVES This study described relations between socioeconomic factors and race/ethnicity as risk factors for asthma mortality. METHODS A cross-sectional study was conducted of US mortality records from 1991 through 1996. RESULTS Higher standardized mortality ratios were seen for Blacks vs Whites (3.34 vs 0.65), low vs high educational level (1.51 vs 0.69), and low vs high income (1.46 vs 0.71). Excess mortality for Blacks vs Whites was present in the highest and lowest quintiles of median county income and educational level. The disparity in asthma mortality rates according to median county income and education remained after control for race/ethnicity. CONCLUSIONS Black race/ethnicity appears to be associated, independently from low income and low education, with an elevated risk for asthma mortality.

Observations on emerging patterns of asthma in our society

Epidemiologic studies of temporal and geographic variation in asthma morbidity have identified asthma as an important public health concern. Knowledge gained from these studies has resulted in intense focus on this condition by agencies such as the National Institutes of Health and the World Health Organization. In this report, studies of recent asthma trends and patterns are explored. These studies show increases in US prevalence through 1994. Data on measures of morbidity show complex longitudinal patterns but are notable for large differences in emergency department services and hospitalizations by age and race. Very recent trends for US asthma mortality suggest widening of an existing racial gap. Limited comparisons are possible between these US trends and international trends but do suggest that US increases in prevalence and mortality rates may reflect world-wide patterns. Also, within the US, it is clear that geographic variation exists in asthma prevalence, morbidity, and mortality rates. Changes in certain environmental risk factors and exposures may contribute to recent trends, but little information is available relating specific risk factors to either longitudinal asthma trends, geographic variability, or high-risk populations.

Prevalence and burden of illness for asthma and related symptoms among kindergartners in Chicago public schools

BACKGROUND Asthma mortality rates in poor communities of Chicago are among the highest in the country. Possible explanations include increased asthma prevalence, increased severity, and suboptimal health care. OBJECTIVE To estimate the prevalence of asthma and asthma-related symptoms among inner-city kindergarten children, and to characterize their burden of illness, asthma-related health care access, and pharmacologic treatment. METHODS Cross-sectional survey of parents of kindergartners was conducted in 11 randomly selected Chicago elementary schools. A self-administered 16-item questionnaire was given to parents of kindergartners. Parents who reported doctor-diagnosed asthma or at least one of several key asthma-related symptoms were then interviewed with a supplemental questionnaire examining asthma-related health care and medication use. RESULTS Based on data from 638 children [mean age 5.7 (SD = 0.6) years], the prevalence of diagnosed asthma was 10.8%. Sixteen percent of the respondents reported that their child had wheezed in the past year. The prevalence of asthma-related symptoms unassociated with a diagnosis of asthma was 30.1%. The children with diagnosed asthma had evidence of a high burden of illness: over 40% were reported to have had sleep disturbance due to wheezing > or =1 to 2 nights/week and 86.6% reported acute care visits for respiratory symptoms in the past year. Self-reported access to medical care was high. Over 40% of the children with doctor diagnosed asthma were reported to have used a beta2-agonist in the preceding 2 weeks, and 12.2% used an inhaled anti-inflammatory. CONCLUSIONS These data suggest that asthma prevalence in school-aged children in inner-city communities may be higher than US estimates. The burden of illness experienced by these children is substantial. Also, a large proportion of children were reported to have respiratory symptoms consistent with asthma, and no asthma diagnosis, suggesting possible undiagnosed asthma. While measures of health care access appear to indicate that the majority of children with asthma experience no identified barriers to health care, there is evidence to suggest undertreatment.

The challenge of inner-city asthma.

Racial and ethnic minorities of low socioeconomic status residing in urban environments currently referred to as inner cities appear to represent a population that is disproportionately at high risk for asthma morbidity and mortality. Epidemiologic studies suggest that key risk factors contributing to asthma morbidity within the inner city include social demography, the physical environment (indoor and outdoor), and health care access and quality. This epidemiologic literature has helped to define opportunities for successful intervention strategies in these high-risk populations. Studies of the effectiveness of community-based and health system-based interventions with specific focus on inner-city populations are beginning to emerge in the literature.

Asthma morbidity and treatment in the Chicago metropolitan area: one decade after national guidelines.

BACKGROUND A number of studies have demonstrated disproportionate hospitalization and mortality rates in US urban areas. Yet, no published population-based studies have examined the burden of asthma on the residents of a particular urban area known to be at high risk for poor asthma outcomes. OBJECTIVES To examine asthma morbidity and medical care in a population-based sample of adults and children with asthma residing in the greater Chicago, IL, metropolitan area and to explore social and demographic influences on morbidity and treatment. METHODS A telephone survey of adults living in the Chicago metropolitan area was conducted from November 1999 through December 2000. RESULTS The final sample included 152 adults and children with active asthma. Emergency department visits and hospitalizations for asthma in the previous year were reported by 25.7% and 6.6% of respondents, respectively. Of current medication users, 32.2% reported current regular use of controller medications. After adjusting for age, sex, income, education, and reported current pharmacotherapy, compared with white individuals, African American individuals remained 6.3 times more likely to have experienced an emergency department visit and 12.3 times more likely to have been hospitalized. CONCLUSIONS These findings suggest that poorly controlled asthma remains a prevalent problem for persons with asthma in this metropolitan area and that a large gap remains between the goals of asthma therapy and appropriate treatment as defined by the National Asthma Education and Prevention Program. The reasons for disparate treatment and health outcomes by race/ethnicity and income need further study and intervention.

The burden of asthma: weighing the community risk against individual risk

During the past few years findings from two studies—the International Study of Asthma and Allergies in Childhood (ISAAC)1 and the European Community Respiratory Health Survey (ECRHS)2—seem to have dominated much of the thinking about the geographical variations in the prevalence of asthma. These studies suggest important variations by geographical site in different countries and, to a lesser extent, in study centres within countries. However, these studies only raise new questions as to how geographical factors contribute to the aetiology of asthma. For example, are the geographical variations in the prevalence of asthma caused by unique exposures to disease causing agents found only in local environments? Do differences in geographical location in some way alter host susceptibility? Do local environmental conditions, either physical or sociocultural, alter the host/agent interactions in ways that are critical to the expression of this condition? In this issue of Thorax Duran-Tauleria and Rona3 further elucidate how social and physical environmental factors may explain some of the geographical expression of asthma prevalence. Their study focuses on the differences in asthma and respiratory symptoms among three populations—two nationally representative samples of English and Scottish children and a third sample of children living within the inner cities of …