Prevalence of Childhood Asthma in Urban Communities: The Impact of Ethnicity and Income
Introduction
Hospitalization rates are often used to measure the burden of asthma in a population because diagnoses are commonly reported to state databases by local hospitals. Studies have shown disparities in asthma hospitalizations, with low-income urban minority neighborhoods having the highest rates 1, 2, 3, 4, 5, 6, 7. Many factors may contribute to the correlation between proportion of low-income minority populations in a neighborhood and high rates of asthma hospitalizations. However, asthma hospitalization rates may not necessarily reflect asthma prevalence. For example, it is possible that higher rates of hospitalizations in neighborhoods of low socioeconomic status (SES) with predominantly low-income minority residents can result from a high proportion of individuals with severe disease, inadequate asthma self-management, and/or lack of access to preventive medical care.
The objectives of the present study were to assess the relationship between hospitalization rates and childhood asthma prevalence within the urban center of New York City and to determine the role of sociodemographic factors in precipitating asthma outcomes. New York City is a prototypical urban center, with a diverse ethnic and socioeconomic population. Asthma prevalence among elementary school children in neighborhoods with varying childhood hospitalization rates and sociodemographic risk factors were compared.
Section snippets
Methods
A cross-sectional parent self-report study was conducted in randomly selected New York City public elementary schools during the 2002–2003 school year. The project was approved by the Mount Sinai Institutional Review Board, by the Mount Sinai Health Insurance Portability and Accountability Act (HIPAA) Privacy Office, and by the Proposal Review Committee of the New York City Department of Education's (DOEs) Division of Assessment and Accountability.
Results
Areas of highest childhood hospitalization rates were clustered in the South Bronx, Harlem, and Central Brooklyn, as seen previously (2) (Fig. 1). Overall, 5374 out of 7310 students returned a questionnaire. Of these, 5250 questionnaires were complete and usable. After adjusting for the average absence rate of each school (12), the response rate was 76.9%. Response rates were slightly higher in the second and third grades; however, all grades had a response rate greater than 70%. The individual
Discussion
Prevalence of current asthma ranged from 6.39% to 17.9%, with an overall prevalence of 13.0%, more than twice recent estimates of national prevalence of 6.3% (13). In areas with the highest asthma hospitalization rates, more than one quarter of the children had ever received an asthma diagnosis. These ZIP Code areas were predominantly low-income minority communities. Even ZIP Code areas with very low asthma hospitalization rates and high numbers of nonminority residents had asthma prevalence at
Conclusions
The strengths of the study are that it presents high response rates in a large sample of urban children, and it provides details about their sociodemographic characteristics and asthma levels. We found that children living in predominantly low-SES communities have significantly high risk of current asthma, independent of their own ethnicity and household income level. Puerto Ricans, especially, have a high risk of asthma, regardless of socioeconomic status. Our data also show that although
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This work was supported in part by the SEARCH Foundation of New York with support from the New York State Department of Health. Additional support was provided by the EPA Region 2 Grant CH98231301 (supplement to R827039) and the New York City Council Speaker's Fund.