Socio-demographic disparities of childhood asthma

Acculturation is associated with asthma burden and pulmonary function in Latino youth: The GALA II study

BACKGROUND

Acculturation is an important predictor of asthma in Latino youth, specifically Mexican Americans. Less is known about acculturation and pulmonary function measures.

OBJECTIVE

We sought to estimate the association of acculturation measures with asthma and pulmonary function in Latino youth and determine whether this association varies across Latino subgroups.

METHODS

We included 1849 Latinos (302 Caribbean Spanish, 193 Central or South Americans, 1136 Mexican Americans, and 218 other Latino children) aged 8 to 21 years from 4 urban regions in the United States. Acculturation measures include nativity status, age of immigration, language of preference, and generation in the United States. We used multivariable logistic and linear regression models to quantify the association of acculturation factors with the presence of asthma (case-control study) and pulmonary function (case-only study), adjusting for demographic, socioenvironmental, and clinical variables.

RESULTS

For all acculturation measures (nativity status, age of immigration, language of preference, and generation in the United States), greater levels of acculturation were associated with greater odds of asthma. Among cases, high (English preference) and medium (equal preference for Spanish and English) levels of language acculturation were associated with decreased bronchodilator response compared with low (Spanish preference) levels (P = .009 and .02, respectively). Similarly, high language acculturation was associated with increased FEV₁ compared with low language acculturation (P = .02). There was insufficient evidence of heterogeneity for associations across Latino subgroups.

CONCLUSIONS

Acculturation was associated with diagnosed asthma and pulmonary function in Latino children and is an important factor to consider in the management of Latino youth with asthma.

Does receiving care in a medical home reduce racial/ethnic disparities in ED visits among children with asthma in the United States?

Evidence has shown the implementation of medical home model improves care quality and outcomes. However, it is not clear whether receiving care from a medical home has any impact on racial/ethnic disparities in emergency department (ED) use by children with asthma. This study using the US National Survey of Children with Special Health Care Needs, 2009-2010, estimated racial/ethnic disparities in ED use. Generalized liner models were used to examine factors associated with ED use. Racial/ethnic differences in ED use were attenuated after adjusting for socio-economic variables. Ratios of prevalence ratios were calculated to examine the effect modification of medical home on ED use associated with race/ethnicity. The adjusted prevalence ratio of ED use of the Black to non-Hispanic White was 1.51 (95% confidence interval (CI): 1.36-1.67) with medical home and 1.35 (95% CI: 1.24-1.47) without medical home. Among those with care from a medical home Latino children had higher ED use compared with White children. There is no evidence that the self-reported care from a medical home narrows the gaps in ED use between non-Hispanic White and Black or Latino children with asthma.

Maternal body mass index before pregnancy is associated with increased bronchodilator dispensing in early childhood: A cross-sectional study

RATIONALE

Maternal prepregnancy obesity has been associated with early wheeze and childhood asthma in their offspring. Some of these studies have been in minority, urban, and disadvantaged populations using parental recall and questionnaires. The association of maternal prepregnancy obesity with bronchodilator dispensing to their offspring, in a primarily insured, non-urban, White population in the United States is unknown.

OBJECTIVES AND METHODS

We conducted a retrospective cohort study using pharmacy dispensing data from the electronic medical records of a large United States health maintenance organization to examine the relationship between maternal prepregnancy body mass index (BMI) and inhaled bronchodilator dispensing in the offspring to 4 years of age. We included infants ≥37 weeks' gestation with birth weight ≥2.5 kg which yielded 6,194 mother-baby pairs. Maternal prepregnancy BMI was categorized as underweight (<18.5 kg/m(2) ), normal (18.5-24.9 kg/m(2) ), overweight (25-29.9 kg/m(2) ), or obese (≥30 kg/m(2) ).

RESULTS

In the entire cohort, 27.6% of the offspring received a bronchodilator dispensing. This ranged from 19.2% in the offspring of underweight mothers to 31.3% of those born to obese mothers. In the fully adjusted model using normal BMI as the referent, children of obese mothers had a 22% higher rate of bronchodilator dispensing (adjusted OR = 1.22; 95%CI 1.05-1.41; P = 0.008).

CONCLUSIONS

In this insured, non-urban, White population, maternal prepregnancy obesity was associated with bronchodilator dispensing in the offspring in early life. These results extend previous data and reaffirm the potential widespread public health impact that prepregnancy obesity may have on subsequent childhood respiratory health. Pediatr Pulmonol. 2016;51:803-811. © 2016 Wiley Periodicals, Inc.

Sex-Based Differences in Asthma among Preschool and School-Aged Children in Korea

The purpose of this study was to explore risk factors related to asthma prevalence among preschool and school-aged children using a representative national dataset from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted from 2009–2011. We evaluated the demographic information, health status, household environment, socioeconomic status, and parents’ health status of 3,542 children aged 4–12 years. A sex-stratified multivariate logistic regression was used to obtain adjusted prevalence odds ratios (ORs) and 95% confidence intervals after accounting for primary sample units, stratification, and sample weights. The sex-specific asthma prevalence in the 4- to 12-year-old children was 7.39% in boys and 6.27% in girls. Boys and girls with comorbid atopic dermatitis were more likely to have asthma than those without atopic dermatitis (boys: OR = 2.20, p = 0.0071; girls: OR = 2.33, p = 0.0031). Boys and girls with ≥1 asthmatic parent were more likely to have asthma than those without asthmatic parents (boys: OR = 3.90, p = 0.0006; girls: OR = 3.65, p = 0.0138). As girls got older, the prevalence of asthma decreased (OR = 0.90, p = 0.0408). Girls residing in rural areas were 60% less likely to have asthma than those residing in urban areas (p = 0.0309). Boys with ≥5 family members were more likely to have asthma than those with ≤3 family members (OR = 2.45, p = 0.0323). The factors related to asthma prevalence may differ depending on sex in preschool and school-aged children. By understanding the characteristics of sex-based differences in asthma, individualized asthma management plans may be established clinically.

Association between asthma and body mass index and socioeconomic status: A cross-sectional study on 849,659 adolescents

BACKGROUND AND OBJECTIVE

Asthma is associated with body mass index (BMI), but its association with socioeconomic status (SES) is controversial. The combined effect of SES and BMI on asthma prevalence is undetermined.

METHODS

Seventeen-year-old pre-recruits to the Israeli Defense Forces underwent routine physical examinations. SES was determined according to established criteria based on place of residence. The study population was divided according to classic weight groups and three SES groups (low, medium and high). Univariable and multivariable logistic regression models were applied to assess odds ratios (OR) of BMI and SES groups for asthma prevalence. The combined effect of BMI and SES was also calculated.

RESULTS

The 849,659 subjects included 480,993 males (9.5% asthma prevalence) and 368,666 females (6.7% asthma prevalence). Increased BMI were associated with increased OR for asthma in females (1.44, 95% CI 1.36-1.52 for obese vs normal weight). Males had a J-shaped curve (OR 1.24 95% CI 1.2-1.29 for obese, 1.12, 95% CI 1.08-1.16 for underweight, both vs normal weight). OR adjusted to SES did not change significantly. All SES groups produced a linear curve (1.59 95% CI 1.53-1.66 for females and 1.79 95% CI 1.74-1.84 for males). Adjustment of SES to BMI produced no significant change in OR. When all groups were compared with the normal weight/lower SES group, the highest OR was for the obese/higher SES group (2.32 95% CI 2.05-2.64 for females and 1.99 95% CI 1.83-2.13 for males).

CONCLUSIONS

Both BMI and SES are co-independently associated with asthma in adolescent males and females.

Family socioeconomic status, household tobacco smoke, and asthma attack among children below 12 years of age: gender differences

Studies have demonstrated the negative impact of environmental tobacco smoke (ETS) or parental cigarette smoking on pediatric asthma. Little is known, however, regarding whether there is a gender difference in the effect of household ETS on pediatric asthma. Using a nationwide survey in Taiwan, we examined the relationship between asthma prevalence in the past year and household ETS among children below 12 years of age (N = 3761). We used multivariate regression models to assess odds ratios (ORs) and 95% confidence intervals (CIs) for the association of household ETS and asthma attacks by gender. In about 3% of the sample, parents reported that their children had an asthma attack in the past year, confirmed by physicians. Multivariate logistic regression revealed that household ETS predicted asthma attacks for girls (OR = 3.11, 95%CI = 1.24-7.76) but not for boys. Father's education was significantly associated with asthma attack for both girls (OR = 1.24, 95%CI = 1.04-1.47) and boys (OR = 1.15, 95%CI = 1.05-1.26). Girls with lower family income were more likely to have had an asthma attack in the last year (OR = .48, 95%CI = .27-.87). The impact of household ETS and family socioeconomic status on asthma attacks differs by gender among children below 12 years.

Socioeconomic status and childhood asthma in urban minority youths. The GALA II and SAGE II studies

RATIONALE

The burden of asthma is highest among socioeconomically disadvantaged populations; however, its impact is differentially distributed among racial and ethnic groups.

OBJECTIVES

To assess the collective effect of maternal educational attainment, annual household income, and insurance type on childhood asthma among minority, urban youth.

METHODS

We included Mexican American (n = 485), other Latino (n = 217), and African American (n = 1,141) children (aged 8-21 yr) with and without asthma from the San Francisco Bay Area. An index was derived from maternal educational attainment, annual household income, and insurance type to assess the collective effect of socioeconomic status on predicting asthma. Logistic regression stratified by racial and ethnic group was used to estimate adjusted odds ratios (aOR) and their 95% confidence intervals (CI). We further examined whether acculturation explained the socioeconomic-asthma association in our Latino population.

MEASUREMENTS AND MAIN RESULTS

In the adjusted analyses, African American children had 23% greater odds of asthma with each decrease in the socioeconomic index (aOR, 1.23; 95% CI, 1.09-1.38). Conversely, Mexican American children have 17% reduced odds of asthma with each decrease in the socioeconomic index (aOR, 0.83; 95% CI, 0.72-0.96) and this relationship was not fully explained by acculturation. This association was not observed in the other Latino group.

CONCLUSIONS

Socioeconomic status plays an important role in predicting asthma, but has different effects depending on race and ethnicity. Further steps are necessary to better understand the risk factors through which socioeconomic status could operate in these populations to prevent asthma.

Factors associated with asthma among under-fives in Mulago hospital, Kampala Uganda: a cross sectional study

BACKGROUND

Asthma is the most common chronic childhood illness, with rapidly increasing prevalence in low-income countries. Among young children, asthma is often under-diagnosed.We investigated the factors associated with asthma among under-fives presenting with acute respiratory symptoms at Mulago hospital, Uganda.

METHODS

A hospital-based cross sectional study of 614 children with cough and/or difficult breathing, and fast breathing, was conducted between August 2011 and June 2012. A questionnaire focusing on clinical history of the child was administered to the caretakers. A physical examination and, laboratory and radiological investigations were done. Asthma was defined according to GINA (Global Initiative for Asthma) guidelines which were modified by excluding the symptom of "chest tightness", spirometry/peak expiratory flow measurements and by adding chest x-ray findings to distinguish asthma from pneumonia. A panel of three paediatricians reviewed the participants' case reports and, guided by the study definitions, made a diagnosis of asthma or other. Multivariable logistic regression analysis was done to determine factors independently associated with asthma.

RESULTS

Of the 614 children, 128 (20.8%) had asthma, 125 (20.4%) bronchiolitis, 167 (27.2%) bacterial pneumonia only, 163 (26.5%) viral pneumonia while 31 (5.1%) had other diagnoses including pulmonary tuberculosis. The majority (71.1%) of children with asthma were aged ≥ 12 months. Factors associated with asthma included maternal asthma (AOR 2.4, 95% CI 1.2, 4.6), a history of allergy in the patient (AOR 2.6, 95% CI 1.2, 5.4,), use of gas for cooking (AOR 3.8, 95% CI 1.2, 13.3), prematurity (AOR 9.3, 95% CI 1.2, 83.3) and high level of education of caretaker (AOR 9.1, 95% CI 1.1, 72.8).

CONCLUSION

Maternal asthma, a history of allergy in the patient, use of gas for cooking, prematurity and high level of education of caretaker were significantly associated with asthma. There is need for studies to explore the role of the above factors in development and exacerbation of childhood asthma to provide information that can be used to design strategies for asthma prevention and control.

Evaluation of breastfeeding promotion, support, and knowledge of benefits on breastfeeding outcomes

We examined how prenatal exposure to breastfeeding information from various media sources, maternal knowledge of benefits, family and clinician support, and peer practices influence breastfeeding outcomes in early infancy. Initiation of breastfeeding, any breastfeeding at two months, and exclusivity of breastfeeding at two months were examined in a cohort of US women using data from the Infant Feeding Practices Study II. Descriptive statistics, chi-square analyses and logistic regression were conducted. Approximately 85 percent of the women initiated breastfeeding. At two months, 63.8 percent continued breastfeeding, while only 38.1 percent breastfed exclusively. Mothers with greater knowledge about breastfeeding benefits were 11.2 (95% CI: 6.87-18.45) times more likely to initiate breastfeeding and 5.62 (95% CI: 4.19-7.54) times more likely to breastfeed at two months than those with lower levels of knowledge. Women whose families prenatally supported exclusive breastfeeding were 8.21(5.12-13.2) times more likely to initiate and continue breastfeeding (OR 3.21, 95% CI: 2.51-4.11). Clinicians who supported breastfeeding only also increased the odds of a woman initiating breastfeeding (OR 1.95, 95% CI: 1.31-2.88). Interventions to increase maternal knowledge of breastfeeding benefits and family and clinician support of breastfeeding in the prenatal period may help increase breastfeeding rates. The encouragement of breastfeeding needs to be a priority among health care providers to improve the health of mothers and infants.

Contextual and cultural risks and their association with family asthma management in urban children

This study examines the association between caregivers' perceptions of home and neighborhood safety on family asthma management in the context of cultural risk factors (e.g., discrimination and acculturative stress) in a sample of urban and ethnic minority families. Participants included 147 children (ages 6-13) and their primary caregiver from Latino, African American and Non-Latino White (NLW) backgrounds. When controlling for poverty, caregivers' perceptions of home and neighborhood safety predicted family asthma management for the overall sample and for the NLW families. Additionally, for caregivers who endorsed higher levels of perceived discrimination, home and neighborhood safety predicted family asthma management. This study demonstrates the utility of considering caregivers' perceptions of home and neighborhood safety when examining urban families' day-to-day engagement with asthma management tasks.

[Social inequalities in health in 4 year-old children in the Hauts-de-Seine (France)]

The social effects on health described in France on newborn and 5- to 6-year-old children suggest the existence of a social gradient among the youngest children. The favoured, though unequal, social situation of the department of the Hauts-de-Seine (France), makes it particularly adapted to this study. A survey, conducted in 2010 by the departmental service of maternal and infantile protection (PMI) on a representative sample of 1227 children, who received check-ups in their first or second year of nursery school, reveals a significant increase of overweight (from 4.6 to 16.5%), of language disorders (from 8.3 to 25.3%), of the orientations to specialized consultations (from 20.6 to 36.6%), according to the socioprofessional category of the father or the social affiliation of the children in the following subgroups: children speaking or understanding a foreign language (36.6% of the sample), children schooled in priority educational zones (equivalent to education achievement zones in UK, 13.6%), children with limited social health coverage (13.4%). In contrast, the BCG and hepatitis B vaccinal coverage is systematically higher in these various groups. The multivariate analysis investigates for each health problem its links with these various subgroups, and with previous child care experiences, and PMI medical consultations. This study suggests therefore further prospects for different actions according to health problems or regarding vaccinal strategy. The development of such routine indicators of disadvantage should allow territorial health services to target their actions towards the decrease of social disparities in health and to check a posteriori the efficiency of the public systems, which have been implemented.