Regardless of income level, black and Hispanic children have more asthma

Neighborhood characteristics, race, and ethnicity have been shown to be risk factors for developing asthma in childhood, suggesting inequalities in children’s respiratory health.

According to a study published in JAMA Pediatrics.

Children from densely populated or poor neighborhoods were also more likely to develop asthma and wheezing.

“Understanding the relationships between race and ethnicity and the physical and social environments of neighborhoods that contribute to the persistence of early childhood wheeze and the onset of asthma is critical to guiding research, policy and interventions to reduce disparities in asthma,” the authors wrote.1

A longitudinal study was conducted to determine associations between measures of neighborhood socioeconomic status and the incidence of childhood wheeze and asthma.

The researchers also examined whether socioeconomic status at the neighborhood level modified the association between race and ethnicity and childhood wheezing and asthma.

The study population included 10 of the 12 cohorts participating in the Children’s Respiratory and Environmental Workgroup consortium, including children born over a 4-decade period in various parts of the United States. Each child’s home address was matched to US census tract data corresponding to their year of birth.

The resulting analysis revealed wide disparities in census socioeconomic indicators by race and ethnicity.

Black and Hispanic children were found to be more likely to reside in neighborhoods with high population density and higher rates of poverty.

In census tracts with high proportions of the population below the poverty line, 49% of children were black, 35% were Hispanic, and only 13% were white.

In areas where proportions of the population were below the poverty line, the majority (83%) of children were white.

Children born in census tracts with higher levels of poverty and lower family income have been identified as having a high risk of wheezing and developing asthma.

Of 5809 children studied, 46% reported wheezing before age 2 and 26% reported persistent wheezing until age 11.

Although the prevalence of asthma at age 11 varied by cohort, black children (RR, 1.47; 95% CI, 1.26-1.73) and Hispanic children (RR, 1.29; 95% CI, 1.09-1.53) had a significantly increased risk of asthma incidence compared with white children.

Black and Hispanic children also experienced an earlier onset incidence of asthma.

Additionally, race and ethnicity persisted as risk factors after adjusting for neighborhood income. The authors suggest this points to the presence of structural inequalities that increase the risk of wheezing and asthma in black and Hispanic children, regardless of neighborhood wealth.

However, the study did not find that neighborhood factors significantly changed asthma risk estimates in black or Hispanic children, although the risk of asthma incidence remained higher in black and Hispanic children in all neighborhoods.

Stress, racial bias and differential access to health care and other resources may persist among Black families in affluent neighborhoods, contributing to asthma risk, the authors note.

These results add to previous studies showing that race, ethnicity and neighborhood factors are associated with disease onset.

The authors suggest that future studies should be conducted taking into account the neighborhood and individual level characteristics that, individually or in combination, account for the high incidence rates of asthma to help guide interventions and treatments. policies aimed at improving the health of those disproportionately affected.

“As with all other health outcomes for which racial disparities have been documented, racial disparities in asthma risk reflect the reality that race is a social construct that serves as a proxy for the complex interactions between genetic ancestry and environmental and social factors related to structure and interpersonal racism,” wrote the authors of an accompanying editorial.2 “Mitigation of racial disparities in asthma risk will require structural solutions and policy changes.”

Reference

1. Antonella Z, Patrick HR, Brent C, et al. childhood asthma incidence, early and persistent wheezing, and neighborhood socio-economic factors in the ECHO/CREW Consortium. JAMA Pediatrician. Published online May 23, 2022. doi:10.1001/jamapediatrics.2022.1446

2. Daniel TM, Tyra CBS, Diana MW. Disparities in childhood asthma – race, location or not keeping up? JAMA Pediatrician. Published online May 23, 2022. doi:10.1001/jamapediatrics.2022.1457

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