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Inner cities include high-risk vulnerable populations of children with asthma.
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Multiple risk factors contribute to morbidity and mortality in inner-city pediatric asthma.
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Environmental and medical interventions that target risk factors have been successful in improving outcomes.
Inner-City Asthma in Childhood
Section snippets
Key points
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:
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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
References (71)
- et al.
Inner-city asthma. The epidemiology of an emerging US public health concern
Chest
(1992) - et al.
Asthma in the inner city: the perspective of the National Institute of Allergy and Infectious Diseases
J Allergy Clin Immunol
(2010) - et al.
Neighborhood poverty, urban residence, race/ethnicity, and asthma: rethinking the inner-city asthma epidemic
J Allergy Clin Immunol
(2015) - et al.
Urban residence, neighborhood poverty, race/ethnicity, and asthma morbidity among children on Medicaid
J Allergy Clin Immunol
(2017) - et al.
Reducing exacerbations in the inner city: lessons from the inner-city asthma consortium (ICAC)
J Allergy Clin Immunol Pract
(2016) - et al.
Inner city asthma
Immunol Allergy Clin North Am
(2015) - et al.
Prematurity as a predictor of childhood asthma among low-income children
Ann Epidemiol
(2008) - et al.
Childhood obesity in an inner-city primary care population: a longitudinal study
J Natl Med Assoc
(2016) - et al.
Pharmacist-led screening program for an inner-city pediatric population
J Am Pharm Assoc (2003)
(2015) - et al.
Relationship of indoor allergen exposure to skin test sensitivity in inner-city children with asthma
J Allergy Clin Immunol
(1998)
Indoor environmental interventions for furry pet allergens, pest allergens, and mold: looking to the future
J Allergy Clin Immunol Pract
Household mouse allergen exposure and asthma morbidity in inner-city preschool children
Ann Allergy Asthma Immunol
Mouse allergen. II. The relationship of mouse allergen exposure to mouse sensitization and asthma morbidity in inner-city children with asthma
J Allergy Clin Immunol
Mouse allergens in urban elementary schools and homes of children with asthma
Ann Allergy Asthma Immunol
Airborne fungi in the homes of children with asthma in low-income urban communities: the Inner-City Asthma Study
J Allergy Clin Immunol
Differential effects of outdoor versus indoor fungal spores on asthma morbidity in inner-city children
J Allergy Clin Immunol
Cities as harbingers of climate change: common ragweed, urbanization, and public health
J Allergy Clin Immunol
Health effects of indoor nitrogen dioxide and passive smoking on urban asthmatic children
J Allergy Clin Immunol
Early-life home environment and risk of asthma among inner-city children
J Allergy Clin Immunol
Pathways through which asthma risk factors contribute to asthma severity in inner-city children
J Allergy Clin Immunol
Outdoor air pollution and asthma
Lancet
Ambient air pollution, lung function, and airway responsiveness in asthmatic children
J Allergy Clin Immunol
Effects of early-life exposure to allergens and bacteria on recurrent wheeze and atopy in urban children
J Allergy Clin Immunol
Anxiety contributes to poorer asthma outcomes in inner-city black adolescents
J Allergy Clin Immunol Pract
Asthma home management in the inner-city: what can the children teach us?
J Pediatr Health Care
A single intervention for cockroach control reduces cockroach exposure and asthma morbidity in children
J Allergy Clin Immunol
Environmental assessment and exposure reduction of rodents: a practice parameter
Ann Allergy Asthma Immunol
Effect of mouse allergen and rodent environmental intervention on asthma in inner-city children
Ann Allergy Asthma Immunol
Management of asthma based on exhaled nitric oxide in addition to guideline-based treatment for inner-city adolescents and young adults: a randomised controlled trial
Lancet
Preseasonal treatment with either omalizumab or an inhaled corticosteroid boost to prevent fall asthma exacerbations
J Allergy Clin Immunol
Distinguishing characteristics of difficult-to-control asthma in inner-city children and adolescents
J Allergy Clin Immunol
Inner-city
Encyclopedia britannica
Trends in allergy prevalence among children aged 0-17 years by asthma status, United States, 2001-2013
J Asthma
Asthma prevalence in Philadelphia: description of two community-based methodologies to assess asthma prevalence in an inner-city population
J Asthma
Cited by (9)
How Schools Can Help Address Social Determinants of Health in Asthma Management
2024, Journal of Allergy and Clinical Immunology: In PracticeCaregiver Depressive Symptoms and Primary Medication Nonadherence in Children With Asthma
2022, Journal of Pediatric Health CareCitation Excerpt :Asthma affects nearly 6.2 million children aged under 18 years, making it one of the most common chronic child health conditions in the United States (Centers for Disease Control and Prevention, 2019a). Not only is asthma more prevalent among racial minority and impoverished children, but morbidity and mortality disproportionately affect these children as well (Akinbami and Centers for Disease Control and Prevention National Center for Health Statistics, 2006; Centers for Disease Control and Prevention, 2019a; Coleman, Teach, & Sheehan, 2019). Racial minority children, especially Black children, have higher rates of uncontrolled asthma, increased emergency health care use for asthma, more missed schools days because of asthma, and a higher asthma-related death rate compared with non-Hispanic, white children with asthma (Akinbami and Centers for Disease Control and Prevention National Center for Health Statistics, 2006; Centers for Disease Control and Prevention, 2019b; Hsu, Qin, Beavers, & Mirabelli, 2016; Zahran, Bailey, Damon, Garbe, & Breysse, 2018).
Long-term effects of a peer-led asthma self-management program on asthma outcomes in adolescent peer leaders
2021, Patient Education and CounselingCitation Excerpt :While morbidity and mortality in adolescents is concerning in general, urban youth bear a disproportionate burden of disease and often have poorer outcomes and quality of life [3,4]. The increased burden of asthma in this population is associated with multiple environmental risk factors such as greater exposure to indoor and outdoor triggers, poverty, and chronic psychosocial stressors [5–7], as well as personal factors, such as suboptimal self-management [8–11] and poor knowledge about symptoms, triggers and medications [9,9,10,11]. This points to the need for an asthma self-management program specifically designed to ameliorate the burden of asthma among urban adolescents.
Disclosure Statement: The authors have no commercial or financial conflicts of interest.