Individual and Neighborhood-Level Factors in Predicting Asthma

Abstract

Purpose of the Study. To investigate the association between asthma and neighborhood-level social and physical indicators. A secondary goal was to identify individual-level predictors for developing childhood asthma. Study Population. Cross-sectional study comprised of 2544 children, aged 5 to 18 years, from a network of 6 Midwestern urban primary care clinics (Indiana University Medical Group in Marion County, Indiana). A total of 1541 black children (947 females and 594 males) and 1003 white children (568 females and 435 males) were evaluated. Methods. A medical chart review was conducted to identify those with physician-diagnosed asthma and record demographic data to ascertain socioeconomic indicators. Other data for neighborhood factors such as median age of housing, family income, education, single-parent family, and language isolation were obtained through the Social Assets and Vulnerabilities Indicators Project. Medical chart data were used to compute age- and gender-adjusted BMI percentiles. Multiple logistic-regression models were used to analyze the data. Results. On the individual level, this study found that asthma prevalence for black children was 4% higher than for white children and that males had a 9% higher risk than females. BMI had different effects for males and females. Males who were normal weight and those at risk of being overweight had similar risks of asthma. However, males who were overweight had a higher risk of asthma than boys who were at risk of being overweight. In contrast, females who were overweight and those at risk of being overweight had similar risks of asthma, and the rates were substantially higher compared with those for females who were normal weight. On the neighborhood level, there was no trend in rising asthma rate with the rise in the median age of housing. Children from very-low-income–level neighborhoods had the same asthma rates as those children from moderate- or middle-income neighborhoods. Conclusions. The authors concluded that in a predominantly urban population of children, the highest likelihood of having asthma is among young, black, overweight males and the lowest rate is among older, white, normal-weight females. There was no association between asthma and neighborhood characteristics or median family incomes. Reviewer Comments. Although the data from this study did not support the hypothesis that lower neighborhood socioeconomic status and older age of homes were associated with childhood risk of asthma, other studies through the National Cooperative Inner-City Asthma Study suggest that other environmental factors may be involved in urban populations, such as higher cockroach, rat, and mouse allergen levels found in inner-city homes and sensitization to these allergens as a risk factor for developing asthma in urban neighborhoods. Asthma is the most common chronic childhood disease; thus, the findings from this study, that increased BMI is associated with increased risk of asthma, is additionally concerning because the rate of childhood obesity is increasing among our nation’s children.