Inner-City Asthma in Childhood

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Key points

  • Inner cities include high-risk vulnerable populations of children with asthma.

  • Multiple risk factors contribute to morbidity and mortality in inner-city pediatric asthma.

  • Environmental and medical interventions that target risk factors have been successful in improving outcomes.

Epidemiology

The prevalence of asthma in inner-city populations remains disproportionately high compared with non-urban areas. Typical rates of asthma prevalence among US children are estimated to be approximately 8% with rates in the inner city up to 28%.5, 6 Overall childhood asthma prevalence seems to have plateaued this decade; however, there remains an increasing prevalence among poor children.5 Keet and colleagues7 demonstrated that the high prevalence of asthma in inner cities is not necessarily due

Race and Ethnicity

Evidence has shown that race and ethnicity are contributing factors to asthma disparities. A nationwide health survey linked to census information identified black children and Puerto Ricans of Hispanic ethnicity as independently at higher risk for current asthma among children.7 In the recent literature, the prevalence of current asthma in black children is twice the prevalence in white children.10 It is often hypothesized that asthma may be underdiagnosed in certain inner-city minority

Pests (cockroaches and mice)

For decades, cockroach and mouse allergens have been well-documented to be implicated in the inner-city asthma problem. Older homes in multiunit buildings with poor upkeep provide the ideal breeding ground for cockroaches and mice. Cockroach allergen is commonly found in inner-city homes and up to 80% of inner-city children have cockroach sensitization.26 The combination of sensitization and exposure to cockroach has been associated with an increased asthma morbidity in these children.27

Interventions and management

In 2012, the President’s Task Force on Environmental Health Risks and Safety Risks to Children published the Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities.56 This action plan combines the collaboration of a broad spectrum of federal agencies that constitute the Asthma Disparities Working Group. The action plan has identified 4 strategies to address the preventable factors leading to asthma disparities. These 4 strategies include:

  • 1.

    Reducing barriers to the

Summary

Residing in the inner city is an established and important risk factor for asthma. The prevalence of asthma remains high in the inner city compared with nonurban areas. This prevalence has been shown to be related not only to the inner-city locale, but also to both extrinsic and intrinsic factors, such as race, ethnicity, and a lower household income. Prematurity and obesity are additional intrinsic risk factors that are common in the inner city. Regarding extrinsic inner-city risk factors for

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    Disclosure Statement: The authors have no commercial or financial conflicts of interest.

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