Poor children living in urban environments have worse asthma and more frequent hospitalizations

Asthma affects 8.6% of all American children and is the leading cause of hospitalization and school absenteeism. Exacerbations of asthma sypmtoms can lead to extended hospital stays and the need for strong courses of anti-inflammatory and bronchodilator drugs. In 2009, 8.4% of people with asthma had to visit the emergency department and 2% of people were admitted for a hospital stay. A research team from Baltimore wanted to know if children who lived in poor or urban environments were at greater risk for being hospitalized for asthma exacerbations.

In this study the researchers identified over 16 million children enrolled in MediCaid in the US from 2009 to 2010, of which 1.5 million had asthma (9.3%). They collected information on their living situation by defining their county of residence as urban, suburban, medium metro, or rural and used the zip code to define their neighborhood poverty score (how poor the neighborhood was). They also defined the race of the child as being either non-Hispanic White, non-Hispanic Black, Hispanic, Asian, or other. Additionally, residence in the inner-city was defined as at least 20% of the households in the area being below the poverty line. When they ran the numbers they found that while living in the inner city was not associated with an increased prevalence of asthma it was associated with a greater risk of visiting the emergency room for asthma related problems (40% greater). Inner city living was also associated with a greater risk of being hospitalized for asthma related problems (62% greater). These relationships existed even after adjusting for race, age, and gender. Additionally, the analysis showed that living in poor urban areas and being a non-Hispanic black were all associated with a greater risk of emergency department visits and hospitalization for asthma related problems.

The researchers saw that the majority of the hospitalizations for asthma were attributable to socioeconomic status and black ethnicity. This study suggests that it is the children of the poorest in the nation who suffer the most from their disease. This is likely to only get worse as cuts to health care get deeper. Despite much research into the role of socioeconomic status on asthma severity, much still has not changed. This research is likely applicable to all other countries with impoverished populations and so a global effort is needed to find a solution. It should be noted that not every state was represented in this data set simply because of the way MediCaid data is collected in each state. Additionally, this study only captures people who go to the hospital for asthma related problems and so doesn’t take into account those who may be having difficulties controlling their asthma but can’t get to a hospital.

Photo Credit: Flickr Joe Green 


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