Disparities in asthma rates amongst Black residents of New York City

Abstract

Background Asthma is a chronic respiratory condition affecting around 300 million people worldwide. In North America, the prevalence of asthma in children and young adults is about 11%. Multiple studies have shown that the burden of asthma was higher in the inner-city when compared to non-inner-city areas. In the United States, African and Hispanic Americans have a higher burden for asthma compared to White Americans. The goal of this study was to differentiate the burden of asthma between US-born and foreign-born Black New York City (NYC) residents. Methods This is a secondary data analysis of the 2014 NYC Health and Nutrition Examination Survey (NYC HANES). The covariates of interest are age, sex, education, income, health insurance, and smoking status. We test for differences in asthma among Black residents of NYC by nativity using a multivariable Cox proportional hazard model with robust estimates by using a constant time for cross-sectional studies. We use domain analysis to maintain the complex survey structure of the data. Standard errors were estimated using Taylor’s Series Linearization, accounting for the complex survey nature of the data collection. We conducted all analyses in SAS OnDemand for Academics®. We set the threshold for significance at 5%. Results The final analytic sample represented a weighted proportion of 24.16% (SE = 1.40). The proportion of US-born Black residents was 61.1% and the proportion of foreign-born Black residents was 38.9%. Univariate analysis indicated that 29.2% of US-born Black NYC residents reported an asthma diagnosis compared to 10.7% of foreign-born Black residents of NYC (p-value < 0.001). The result of the covariate-adjusted model indicated that foreign-born Black NYC residents had a significantly lower prevalence of asthma compared to US-born (PR = 0.40, 95% CI = 0.21-0.76). Additionally, those who are 65 years and older had a lower asthma risk compared to those 20-34 years old. Conclusion This study shows that asthma is found in higher rates amongst US-born Black NYC residents as opposed to foreign-born. Further studies should investigate this result in a national sample. Also, studies should investigate association of acculturation to asthma outcome in foreign-born population.