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Titus AR, Terlizzi K, Conderino S, Ðoàn LN, Kim B, Thorpe LE. Patterns and drivers of disparities in pediatric asthma outcomes among Medicaid-enrolled children living in subsidized housing in NYC. Prev Med 2024; 185:108023. [PMID: 38908569 DOI: 10.1016/j.ypmed.2024.108023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/13/2024] [Accepted: 05/29/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE There are persistent disparities in pediatric asthma morbidity in the U.S. We linked claims data with information on neighborhood-level risk factors to explore drivers of asthma disparities among Medicaid-enrolled children in New York City subsidized housing. METHODS We constructed a cohort of Medicaid-enrolled children living in public or other subsidized housing, based on residential address, in NYC between 2016 and 2019 (n = 108,969). We examined claims-derived asthma prevalence across age and racial and ethnic groups, integrating census tract-level information and using the Bayesian Improved Surname Geocoding (BISG) algorithm to address high rates of missing data in self-reported race and ethnicity. We used inverse probability weighting (IPW) to explore the extent to which disparities persisted when exposure to asthma risk factors - related to the built environment, neighborhood poverty, and air quality - were balanced across groups. This analysis was conducted in 2022-2023. RESULTS Claims-derived asthma prevalence was highest among children <7 years at baseline and among non-Hispanic Black and Hispanic children. For example, among children aged 3-6 years at baseline, claims-derived prevalence was 17.3% and 18.1% among non-Hispanic Black and Hispanic children, respectively, compared to 9.3% and 9.0% among non-Hispanic White and non-Hispanic Asian American/Pacific Islander children. Using IPW to balance exposure to asthma risk factors across racial and ethnic groups attenuated, but did not eliminate, disparities in asthma prevalence. CONCLUSIONS We found high asthma burden among children living in subsidized housing. Modifiable place-based characteristics may be important contributors to pediatric asthma disparities.
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Affiliation(s)
- Andrea R Titus
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America.
| | - Kelly Terlizzi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Sarah Conderino
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Lan N Ðoàn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Byoungjun Kim
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Lorna E Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
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Bender BG, Crooks J, Gerald JK, Hudson B, King DK, Kobernick A, Liu AH, Lowe AA, Morgan W, Nez P, Phan H, Wightman P, Gerald LB. Childhood asthma exacerbations on the Navajo Nation. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00429-X. [PMID: 38697473 DOI: 10.1016/j.jaip.2024.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Bruce G Bender
- Division of Biostatistics, Department of Pediatrics, Center for Health Promotion, National Jewish Health, Denver, Colo.
| | - James Crooks
- Division of Biostatistics, Department of Pediatrics, Center for Health Promotion, National Jewish Health, Denver, Colo
| | - Joe K Gerald
- Advanced Nursing and Science Division, College of Nursing, Department of Public Health Practice, Policy and Translational Research, Pulmonary and Sleep Medicine, The Zuckerman College of Public Health, Center for Population Science and Discovery, University of Arizona, Tucson, Ariz
| | - Bryan Hudson
- Division of Biostatistics, Department of Pediatrics, Center for Health Promotion, National Jewish Health, Denver, Colo
| | - Diane K King
- Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, Alaska
| | - Aaron Kobernick
- Section of Allergy and Immunology, Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Andrew H Liu
- The Breathing Institute, Childrens Hospital Colorado, University of Colorado, Denver, Colo
| | - Ashley A Lowe
- Advanced Nursing and Science Division, College of Nursing, Department of Public Health Practice, Policy and Translational Research, Pulmonary and Sleep Medicine, The Zuckerman College of Public Health, Center for Population Science and Discovery, University of Arizona, Tucson, Ariz
| | - Wayne Morgan
- Advanced Nursing and Science Division, College of Nursing, Department of Public Health Practice, Policy and Translational Research, Pulmonary and Sleep Medicine, The Zuckerman College of Public Health, Center for Population Science and Discovery, University of Arizona, Tucson, Ariz
| | - Peter Nez
- Division of Biostatistics, Department of Pediatrics, Center for Health Promotion, National Jewish Health, Denver, Colo
| | - Hanna Phan
- Clinical Pharmacy, University of Michigan, Ann Arbor, Mich
| | - Patrick Wightman
- Advanced Nursing and Science Division, College of Nursing, Department of Public Health Practice, Policy and Translational Research, Pulmonary and Sleep Medicine, The Zuckerman College of Public Health, Center for Population Science and Discovery, University of Arizona, Tucson, Ariz
| | - Lynn B Gerald
- Office of Population Health Sciences, Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Ill
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Chen M, Bacong AM, Feng C, Kikuta NT, Datir RR, Chen S, Srinivasan M, Camargo CA, Palaniappan L, Arroyo AC. Asthma heterogeneity among Asian American children: The California Health Interview Survey. Ann Allergy Asthma Immunol 2024; 132:368-373.e2. [PMID: 37949352 PMCID: PMC10922489 DOI: 10.1016/j.anai.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The Asian American (AsA) population is heterogenous and rapidly growing; however, little is known regarding childhood asthma burden among AsA ethnic groups. The relation between obesity and asthma in AsA ethnic groups also remains unclear. OBJECTIVE To evaluate asthma prevalence and the relation of obesity to asthma risk among children in 7 AsA ethnic groups. METHODS We analyzed data from the California Health Interview Survey from 2011 to 2020. AsA ethnicities were self-reported. Body mass index z-scores, calculated from self-reported height/weight, were used to categorize children by obesity status, based on body mass index-for-age growth charts. Prevalence of self-reported lifetime doctor-diagnosed asthma and asthma attack in the last 12 months was calculated. We performed multivariable logistic regressions adjusting for age and sex. RESULTS Of 34,146 survey respondents, 12.2% non-Hispanic White and 12.5% AsA children reported lifetime asthma. Among AsA ethnic groups, however, lifetime asthma ranged from 5.1% (Korean American) to 21.5% (Filipino American). Non-Hispanic White children and AsA children had a similar lifetime asthma prevalence (adjusted odds ratio [aOR], 1.05; 95% CI, 0.71-1.55; P = .81), but prevalence was lower in Korean American children (aOR, 0.37; 95% CI, 0.19-0.73; P = .004) and higher in Filipino American children (aOR, 1.97; 95% CI, 1.22-3.17; P = .006). The lifetime asthma prevalence of different AsA ethnic groups persisted even when stratified by obesity status. CONCLUSION Childhood lifetime asthma prevalence varied among AsA ethnic groups, with lowest prevalence in Korean American children and highest prevalence in Filipino American. Further characterization of asthma burden among AsA ethnic groups may help guide asthma screening and prevention measures and offer new insights into asthma pathogenesis.
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Affiliation(s)
- Meng Chen
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Stanford Center for Asian Health Research and Education, Stanford, California.
| | - Adrian Matias Bacong
- Stanford Center for Asian Health Research and Education, Stanford, California; Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Charles Feng
- Division of Allergy/Immunology, Palo Alto Medical Foundation, Mountain View, California
| | | | - Rohan Rahul Datir
- Stanford Center for Asian Health Research and Education, Stanford, California
| | - Shihua Chen
- Stanford Center for Asian Health Research and Education, Stanford, California
| | - Malathi Srinivasan
- Stanford Center for Asian Health Research and Education, Stanford, California; Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Carlos A Camargo
- Department of Emergency Medicine and Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Latha Palaniappan
- Stanford Center for Asian Health Research and Education, Stanford, California; Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Epidemiology and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Anna Chen Arroyo
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Stanford Center for Asian Health Research and Education, Stanford, California
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Arroyo AC, Ko J, Chandra M, Huang P, Darbinian JA, Palaniappan L, Lo JC. Risk of Incident Asthma Among Young Asian American, Native Hawaiian, and Pacific Islander Children from Age 3 to 7 Years in a Northern California Healthcare System. J Pediatr 2024; 265:113802. [PMID: 37898424 DOI: 10.1016/j.jpeds.2023.113802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
Incident childhood asthma risk has not been examined among diverse Asian American, Native Hawaiian, and Pacific Islander subgroups. In a large California healthcare system, incident asthma was higher among young Filipino/a, Native Hawaiian/Pacific Islander, and South Asian children compared with non-Hispanic White children, whereas Chinese and Japanese children were similar.
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Affiliation(s)
- Anna Chen Arroyo
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA; Stanford Center for Asian Health Research and Education, Stanford, CA
| | - Jimmy Ko
- Permanente Medical Group, Department of Allergy, Kaiser Permanente Fremont Medical Center, Fremont, CA
| | - Malini Chandra
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Polly Huang
- Department of Medicine, Kaiser Permanente Oakland Medicine Center, Oakland, CA
| | - Jeanne A Darbinian
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Latha Palaniappan
- Stanford Center for Asian Health Research and Education, Stanford, CA; Division of Cardiovascular Medicine and Division of Epidemiology and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Joan C Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.
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Zhou Z, Zhang H, Yuan Y. Association between IL10 rs1800896 polymorphism and risk of pediatric asthma: A meta-analysis. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:1276-1285. [PMID: 37937689 PMCID: PMC10730469 DOI: 10.1111/crj.13714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/28/2023] [Accepted: 10/14/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Asthma is a common chronic condition in children. Several studies have explored the potential association between IL10 rs1800896 polymorphism and the risk of asthma in children, but the findings have been inconsistent. To address these discrepancies, we conducted a systematic review and meta-analysis to assess the relationship between IL10 rs1800896 polymorphisms and the susceptibility to pediatric asthma. METHODS A literature search was conducted in PubMed, Scopus, Web of Science, and CNKI databases to identify eligible studies through April 2022. Meta-analysis was then performed using five genetic models: dominant, recessive, homozygous, heterozygous, and allele. RESULTS A total of 12 studies comprising 1645 cases along with 1447 controls were included in this meta-analysis. It was found that rs1800896 was not associated significantly with susceptibility to childhood asthma in all genetic models investigated. Subgroup analysis based on the ethnic background of the subjects revealed that rs1800896 was significantly linked to a lower risk of pediatric asthma among Asians in the homozygous model (OR = 0.311, 95% CI = 0.152-0.637, P = 0.001) and in the recessive model (OR = 0.585, 95% CI = 0.405-0.846, P = 0.004), whereas no significant relationship was observed in Egyptians (P > 0.05). CONCLUSION In conclusion, IL10 rs1800896 polymorphism may be useful as a predictive marker for childhood asthma in Asians, although further studies are needed to validate the study results.
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Affiliation(s)
- Zhihong Zhou
- School of NursingHebi PolytechnicHebiChina
- SeHan UniversityYeongam‐gunJeollanam‐doRepublic of Korea
| | - Hui Zhang
- Department of HepatopathyHunan Children's HospitalChangshaChina
| | - Yuanhong Yuan
- Emergency CenterHunan Children's HospitalChangshaChina
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Efficacy and feasibility of the BREATHE asthma intervention with American Indian children: a randomized controlled trial. Sci Rep 2022; 12:21220. [PMID: 36482065 PMCID: PMC9731995 DOI: 10.1038/s41598-022-25447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
American Indian (AI) children experience significant disparities in asthma prevalence, severity, and burden of disease, yet few asthma education interventions are tested in this population. This study aimed to evaluate the efficacy and feasibility of the BREATHE intervention with parents and AI children, during a 3-year follow-up period (n = 108), using a randomized controlled design. Children with asthma identified by electronic medical records (EMR) were screened and matched with 2 controls. The intervention included an initial educational and 24 months of follow-up. The control group continued their usual care. The primary outcome was the frequency of EMR documented, emergency department (ED) visits or hospitalization for respiratory complaints. There was no statistical difference in mean primary outcomes (1.34 (1.98) vs 1.22 (1.95), - 0.88 to 0.63, 95% CI of the difference, p = 0.75), nor percent with any ED visit or hospitalization (29/53, 55% vs 30/55, 54%, p = 0.99) between the intervention or control groups respectively. After 365 days, there was a borderline significant difference in time to primary outcome. Although limited in power, the present study did not demonstrate a persistent effect of this intervention. We recommend that AI pediatric asthma interventions are culturally-designed, use feasible procedures, and repeat education at least every 12 months.
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Depression in Childhood Asthma vs. Adult-Onset Asthma: A Cross-Sectional Study from the National Health and Nutrition Examination Survey (NHANES). CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121797. [PMID: 36553241 PMCID: PMC9776752 DOI: 10.3390/children9121797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/27/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022]
Abstract
Background: asthma, a chronic respiratory disease caused by inflammation and narrowing of the small airways in the lungs, is the most common chronic childhood disease. Prevalence of childhood asthma in the United States is 5.8%. In boys, prevalence is 5.7% and it is 6% in girls. Asthma is associated with other comorbidities such as major depressive disorder and anxiety disorder. This study explores the association between asthma and depression. Methods: we conducted a retrospective cross-sectional study using NHANES data from 2013 to 2018. Asthma and childhood onset asthma were assessed using questionnaires MCQ010 and MCQ025, respectively. Sociodemographic variables were summarized, and univariate analysis was performed to determine the association between asthma and major depressive disorder and its individual symptoms. Results: there were 402,167 participants from 2013−2018 in our study: no asthma in 84.70%; asthma in 15.30%. Childhood onset asthma (COA) included 10.51% and adult-onset asthma (AOA) included 4.79%. Median age of COA is 5 years and AOA is 41 years. Among the asthma groups, most AOA were females (67.77%, p < 0.0001), most COA were males (52.16%, p < 0.0001), and ethnicity was predominantly White in AOA (42.39%, p < 0001) and in COA (35.24%, p < 0.0001). AOA mostly had annual household income from $0−24,999 (35.91%, p < 0.0001), while COA mostly had annual household income from $25,000−64,999 (36.66%, p < 0.0001). There was a significantly higher prevalence of MDD in COA (38.90%) and AOA (47.30%) compared to NOA (31.91%). Frequency of symptoms related to MDD were found to have a significantly higher prevalence and severity in the asthma groups compared to no asthma, and slightly greater and more severe in AOA than in COA. Symptoms include having little interest in doing things (COA 18.38% vs. AOA 22.50% vs. NOA 15.44%), feeling down, depressed, or hopeless (COA 20.05% vs. AOA 22.77% vs. NOA 15.85%), having trouble sleeping or sleeping too much (COA 27.38% vs. AOA 23.15% vs. NOA 22.24%), feeling tired or having little energy (COA 39.17% vs. AOA 34.24% vs. NOA 33.97%), having poor appetite or overeating (COA 19.88% vs. AOA 20.02% vs. NOA 15.11%), feeling bad about yourself (COA 13.90% vs. AOA 13.79% vs. NOA 10.78%), having trouble concentrating on things (COA 12.34% vs. AOA 14.41% vs. NOA 10.06%), moving or speaking slowly or too fast (COA 8.59% vs. AOA 9.72% vs. NOA 6.09%), thinking you would be better off dead (COA 3.12% vs. AOA 4.38% vs. NOA 1.95%) and having the difficulties these problems have caused (COA 21.66% vs. AOA 26.73% vs. NOA 19.34%, p < 0.0001). Conclusion: MDD and related symptoms were significantly higher and more severe in participants with asthma compared to no asthma. Between adult-onset asthma compared to childhood onset asthma, adult-onset asthma had slightly greater and more severe MDD and related symptoms compared to childhood onset asthma.
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What Is "Socioeconomic Position (SEP)," and How Might It Modify Air Pollution-Health Associations? Cohering Findings, Identifying Challenges, and Disentangling Effects of SEP and Race in US City Settings. Curr Environ Health Rep 2022; 9:355-365. [PMID: 35511352 PMCID: PMC9363384 DOI: 10.1007/s40572-022-00359-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/30/2022]
Abstract
Purpose of Review Environmental epidemiology has long considered socioeconomic position (SEP) to be an important confounder of pollution effects on health, given that, in the USA, lower-income and minority communities are often disproportionately exposed to pollution. In recent decades, a growing literature has revealed that lower-SEP communities may also be more susceptible to pollution. Given the vast number of material and psychosocial stressors that vary by SEP, however, it is unclear which specific aspects of SEP may underlie this susceptibility. As environmental epidemiology engages more rigorously with issues of differential susceptibility, it is pertinent to define SEP more clearly, to disentangle its many aspects, and to move towards identifying causal components. Myriad stressors and exposures vary with SEP, with effects accumulating and interacting over the lifecourse. Here, we ask: In the context of environmental epidemiology, how do we meaningfully characterize”SEP”? Recent Findings In answering this question, it is critical to acknowledge that SEP, stressors, and pollution are differentially distributed by race in US cities. These distributions have been shaped by neighborhood sorting and race-based residential segregation rooted in historical policies and processes (e.g., redlining), which have served to concentrate wealth and opportunities for education and employment in predominantly-white communities. As a result, it is now profoundly challenging to separate SEP from race in the urban US setting. Summary Here, we cohere evidence from our recent and on-going studies aimed at disentangling synergistic health effects among SEP-related stressors and pollutants. We consider an array of SEP-linked social stressors, and discuss persistent challenges in this epidemiology, many of which are related to spatial confounding among multiple pollutants and stressors. Combining quantitative results with insights from qualitative data on neighborhood perceptions and stress (including violence and police-community relations), we offer a lens towards unpacking the complex interplay among SEP, community stressors, race, and pollution in US cities.
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Bukstein DA, Friedman A, Gonzalez Reyes E, Hart M, Jones BL, Winders T. Impact of Social Determinants on the Burden of Asthma and Eczema: Results from a US Patient Survey. Adv Ther 2022; 39:1341-1358. [PMID: 35072886 PMCID: PMC8784588 DOI: 10.1007/s12325-021-02021-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
Abstract
Introduction Little is known about how patients with asthma and eczema perceive their medical care and burden of disease. A survey was conducted to evaluate the perceptions among the general patient population with asthma and/or eczema regarding disease and treatment burden and barriers to adequate care. Methods An online survey was completed by market research panelists in the USA between March 24, 2020 and April 6, 2020. Eligible participants were at least 18 years of age and endorsed a diagnosis of asthma and/or eczema. Survey responses are described for all participants, by designated racial/ethnic groups, and by income level. Results In all, 841 participants completed the survey (asthma, n = 554; eczema, n = 398; both, n = 111; White, n = 421; Black, n = 252; Hispanic, n = 95; low income [less than $15,000/year], n = 99; higher income [at least $15,000/year], n = 713). More Black and Hispanic participants than White participants, and more participants with low income than higher income, endorsed health literacy as a barrier (e.g., filling out official documents, understanding written materials). Participants with low income were less likely than participants with higher income to have an asthma action plan (42% vs 53%, respectively) and to discuss asthma control with their healthcare provider (54% vs 69%). Black and Hispanic participants were more likely than White participants to have an emergency department visit (52% and 49% vs 31%, respectively) or hospitalization (31% and 39% vs 16%) for asthma within the last 12 months. Participants reporting low income indicated that they experienced eczema symptoms more frequently than participants with higher income; 35% of low-income participants vs 15% of higher-income participants reported that they had not tried any eczema treatments. Participants in all racial/ethnic and income-level groups reported that their asthma or eczema impacted their lifestyle and daily activities. Conclusion More effective and culturally informed communication and education strategies to improve health information uptake and shared decision-making are needed to reduce the burdens of disease and treatment in highly impacted populations. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-02021-0. Disparities in asthma and eczema outcomes have been described in various populations. However, little is known about how these patient populations perceive their disease management or disease burden. A survey of 841 adults across diverse demographic groups in the USA with asthma and/or eczema was conducted to evaluate overall perceived disease burden and to specifically understand burden experiences by marginalized populations. In general, all participants indicated that asthma and eczema have a negative physical, emotional, and social impact on their lives. Some participants who identified as Black or Hispanic, and those with low income (less than $15,000/year), indicated greater difficulties in filling out paperwork or understanding written materials related to their condition than White participants or those with higher incomes. Black and Hispanic participants tended to receive asthma care in the emergency department or urgent care more than White participants and had more emergency department visits and hospitalizations than White Participants. Participants with low income were less likely to discuss their asthma management with their doctor than those with higher incomes and also indicated potential undertreatment of eczema. These results indicate that Black, Hispanic, or low-income patients may experience barriers to health equity. These barriers include lack of effective communication methods and materials to meet the needs of all patients, as well as the overall lack of quality healthcare access. These challenges must be addressed to overcome social disparities in health.
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Affiliation(s)
| | - Adam Friedman
- Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Erika Gonzalez Reyes
- Department of Internal Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Mary Hart
- Allergy & Asthma Network, Vienna, VA, USA
| | - Bridgette L Jones
- Children's Mercy Kansas City & University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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Hester G, Nickel AJ, Watson D, Bergmann KR. Factors Associated With Bronchiolitis Guideline Nonadherence at US Children's Hospitals. Hosp Pediatr 2021; 11:1102-1112. [PMID: 34493589 DOI: 10.1542/hpeds.2020-005785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The objective with this study was to explore factors associated with nonadherence to national bronchiolitis guidelines at 52 children's hospitals. METHODS We included patients 1 month to 2 years old with emergency department (ED) or admission encounters between January 2016 and December 2018 and bronchiolitis diagnoses in the Pediatric Health Information System database. We excluded patients with any intensive care, stay >7 days, encounters in the preceding 30 days, chronic medical conditions, croup, pneumonia, or asthma. Guideline nonadherence was defined as receiving any of 5 tests or treatments: bronchodilators, chest radiographs, systemic steroids, antibiotics, and viral testing. Nonadherence outcomes were modeled by using mixed effects logistic regression with random effects for providers and hospitals. Adjusted odds ratio (aOR) >1 indicates greater likelihood of nonadherence. RESULTS A total of 198 028 encounters were included (141 442 ED and 56 586 admission), and nonadherence was 46.1% (ED: 40.2%, admissions: 61.0%). Nonadherence increased with patient age, with both ED and hospital providers being more likely to order tests and treatments for children 12 to 24 months compared with infants 1 ot 2 months (ED: aOR, 3.39; 95% confidence interval [CI], 3.20-3.60; admissions: aOR, 2.97; CI, 2.79-3.17]). Admitted non-Hispanic Black patients were more likely than non-Hispanic white patients to receive guideline nonadherent care (aOR, 1.16; CI, 1.10-1.23), a difference driven by higher use of steroids (aOR, 1.29; CI, 1.17-1.41) and bronchodilators (aOR, 1.39; CI, 1.31-1.48). Hospital effects were prominent for viral testing in ED and admission encounters (intraclass correlation coefficient of 0.35 and 0.32, respectively). CONCLUSIONS Multiple factors are associated with national bronchiolitis guideline nonadherence.
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Affiliation(s)
| | | | | | - Kelly R Bergmann
- Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota
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Banta JE, Ramadan M, Alhusseini N, Aloraini K, Modeste N. Socio-demographics and asthma prevalence, management, and outcomes among children 1-11 years of age in California. Glob Health Res Policy 2021; 6:17. [PMID: 34039445 PMCID: PMC8157798 DOI: 10.1186/s41256-021-00199-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 05/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Asthma disproportionately affects minority and low-income children. We examined asthma prevalence, management and outcomes, focusing on race/ethnicity and acculturation of parents (particularly English language proficiency). Methods This cross-sectional, correlational analysis used a de-identified population-based survey, the California Health Interview Survey, for years 2001–2015. Survey-weighted analysis with SAS 9.4 was used to determine asthma prevalence among children 1 to 11 years of age. Descriptive analysis was conducted, adjusting for survey design and combination of multiple years of data. The Pearson test, using design-based F values was used to determine statistically significant differences between those having/not having a doctor diagnosis of asthma. Multivariable logistic regression, with jackknife approach to obtain confidence intervals, was used to examine associations of child and parental characteristics with asthma prevalence, management, and outcomes. Results The 61,625 completed surveys represented an estimated annual population of 5.7 million children, of which 12.9 % had asthma. There were significant (p < 0.001) differences by age, gender, race, and language proficiency, with higher asthma prevalence for children 6 to 11 years of age (15.5 %), males (15.3 %), African Americans (19.5 %), and parents speaking English very well (14.1 %). Compared to children whose parents spoke English very well, those whose parents spoke English not well or not at all were less likely to achieve optimal asthma management, i.e. to have received a management plan from doctor (OR 0.30; 95 % Confidence Interval 0.20–0.46)), to be currently taking medication to control asthma (OR 0.52; 95 % CI 0.36–0.74)), or to be not confident in ability to control asthma (OR 3.10; 95 % CI 1.49–6.42). Children whose parents spoke English fairly well rather than very well had worse outcomes, i.e. were more likely to have an emergency room visit in past 12 months (OR 1.92; 95 % CI 1.03–3.61) and were more likely to miss school due to asthma in past 12 months (OR 0.71; 1.01–2.94). Conclusions Socio-demographics had a limited role in explaining differences across a handful of asthma management and outcome measures in California. Parental English language proficiency had the most consistent influence, underscoring the need for culturally and linguistically competent care.
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Affiliation(s)
- Jim E Banta
- Loma Linda University School of Public Health, 24951 Circle Dr, CA, 92354, Loma Linda, USA.
| | - Majed Ramadan
- Loma Linda University School of Public Health, 24951 Circle Dr, CA, 92354, Loma Linda, USA
| | - Noara Alhusseini
- College of Medicine, Alfaisal University, 7746 Ibrahim Alziady St., Alwurud District, 12253 2499, Riyadh, Saudi Arabia
| | - Khaled Aloraini
- Loma Linda University School of Public Health, 24951 Circle Dr, CA, 92354, Loma Linda, USA
| | - Naomi Modeste
- Loma Linda University School of Public Health, 24951 Circle Dr, CA, 92354, Loma Linda, USA
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Balkissoon R. Journal Club: The Intersection of Racial/Ethnic Disparities in Coronavirus Disease 2019 and COPD. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2021; 8:292-302. [PMID: 33909967 DOI: 10.15326/jcopdf.2021.0227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Brooks JL, Asafu-Adjei J, Currin EG, Beeber LS. Exploring a broader context of the home environment and its relationship with asthma control in American Indian children. Res Nurs Health 2020; 43:218-229. [PMID: 32274808 DOI: 10.1002/nur.22020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/13/2020] [Accepted: 03/28/2020] [Indexed: 11/06/2022]
Abstract
In this cross-sectional study of 60 American Indian mother-child dyads from Southeastern North Carolina, we examined whether childhood asthma control was related to household-level factors, such as environmental tobacco smoke and family management behaviors. We also examined the relationships among family management behaviors and maternal depressive symptoms. We used logistic regression to assess the relationships among childhood asthma control, the presence of environmental tobacco smoke, and family management behaviors, specifically condition management ability (CMA) and condition management effort (CME). We used linear regression to evaluate the relationships between both CMA and CME and maternal depressive symptoms. Better asthma control in children was associated with the absence of environmental tobacco smoke in the home and the maternal perception of asthma as a manageable condition. Mothers perceived an increase in effort to manage their child's asthma as their depressive symptoms increased. These findings emphasize the importance of environmental triggers, perceptions of condition management, and maternal mental health in controlling asthma in American Indian children. Interventions to reduce environmental triggers, treat maternal depressive symptoms, and support mothers in their ability to manage childhood asthma may yield better asthma control and help to reduce existing racial disparities in this population.
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Affiliation(s)
- Jada L Brooks
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Josephine Asafu-Adjei
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily G Currin
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Linda S Beeber
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Stern J, Pier J, Litonjua AA. Asthma epidemiology and risk factors. Semin Immunopathol 2020; 42:5-15. [PMID: 32020334 DOI: 10.1007/s00281-020-00785-1] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/15/2020] [Indexed: 12/20/2022]
Abstract
Asthma is a clinical syndrome that affects all age groups. Asthma prevalence worldwide has seen a rapid increase in the latter part of the last century. Recent data has shown that asthma prevalence has plateaued and even decreased in some areas of the world, despite continuing to increase in other areas of the world. Many risk factors have been associated with asthma and the differences in distributions of these risk factors may explain the differences in prevalence. This article will review recent trends in the prevalence of asthma and recent studies that investigate risk factors of asthma.
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Affiliation(s)
- Jessica Stern
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Division of Allergy and Immunology, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Jennifer Pier
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Division of Allergy and Immunology, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, 601 Elmwood Avenue, Box 667, Rochester, NY, 14642, USA. .,Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
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