Inner-city living linked to poor asthma control in kids

Living in a poor-urban area could be independently linked to poor asthma control even after accounting for race and ethnicity, according to a new study published in The Journal of Allergy and Clinical Immunology: In Practice.

“There is ample evidence of the higher asthma morbidity experienced by children who reside in poor-urban areas,” wrote the authors, led by Patrick W. Sullivan, PhD, Regis University School of Pharmacy, Denver, CO. “However, less is known about the relationship between asthma morbidity and poor-urban residence with respect to other factors like race, ethnicity, or other individual characteristics.”

In this population-based study, Dr. Sullivan and colleagues assessed the correlation between poor-urban residence and patient characteristics—race, ethnicity, comorbidity, and smoking status—and a variety of asthma treatment and disease measures.

Researchers mined the 2000-2014 Medical Expenditure Survey (MEPS) for asthma measures in children between the ages of 1 and 17 years. They compared asthma treatments and control measures based on place of residence in a nationally representative sample spanning all 50 states during a period of 15 years.

The team looked at the following indicators of poorly controlled asthma and treatment measures:

• Self-reported utilization of more than three canisters of a short-acting beta agonist (SABA) in 3 months
• Self-reported asthma exacerbation during the past year
• Emergency department or inpatient hospitalization during the past year
• Utilization of controller medications
• Ratio of controller-to-total prescriptions of ≥ 0.7

The team also controlled for covariates, including insurance status, race, gender, age, Hispanic ethnicity, region, comorbidities, family smoking history, and year of survey.

After adjusting for these confounding variables, the researchers found that children with asthma living in poor-urban areas were less likely to use controller medications, demonstrate a ratio of controller-to-total prescriptions of ≥ 0.7, and report an asthma attack. These children were more likely to visit the emergency department or be hospitalized.

African American race and Hispanic ethnicity were significantly linked to increased likelihood of profligate SABA utilization and hospital visits to the ED or inpatient. These variables were also linked to decreased likelihood of having a controller-to-total prescriptions ratio of ≥ 0.7.

The team also found that comorbidities and exposure to smoking family members are positively correlated with asthma morbidity, which are novel findings.

The authors acknowledge potential limitations of this study. First, because of its cross-sectional design, this study cannot be used to determine causation. Second, although the results of this study were controlled for survey year, relationships could have changed during time. Third, much of the data are self-reported and thus prone to bias.

“This study shows that there are health disparities in asthma morbidity and treatment based on a child’s residence, race, and ethnicity,” the researchers concluded. “Given the natural history of asthma morbidity, this implies that the health disparities will continue into adulthood if not addressed during childhood. Increased attention and vigilance toward understanding and combating modifiable geographic and individual challenges is paramount.” 

This study was funded by Novartis.

To read more about the study, click here.