August 1997
SAN FRANCISCO — Studies indicate that along with the crippling social diseases of crime, poverty and despair, many urban minority communities are also enduring the disproportionate morbidity and mortality of asthma, according to a recent report at the American Thoracic Society meeting.
To determine the effects of city air pollution and social factors on urban children with asthma, researchers from Children's Hospital of Cleveland examined a cross-section of minority children from New York City and Baltimore to identify risk factors.
The children, whose ages ranged from 4 to 9, and their families were interviewed and tested over a three-year period. To qualify, the subjects had to live at or below the poverty line and in the city for more than five years. No control groups were used.
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"There have been a number of studies over the last decade identifying children who live in poverty, particularly those in minority groups who live in central urban areas and suffer morbidity and mortality due to asthma," said Carol Kercsmar, MD, of the Children's Hospital in Cleveland and lead author of the study. "Our study found the causes for this lie in a number of areas, such as environmental and economic risks, psychosocial risks, impaired access to health care as well as the content and quality of that health care."
Race and socioeconomic factors, family income and place of residence all played key roles in perpetuating the spread of asthma, Kercsmar said.
Random surveys conducted in New York City found a high percentage of undiagnosed asthma among Hispanic children in the Bronx. With the national average around 5%, Kercsmar was stunned to discover that close to 15% of the Hispanic children interviewed showed asthma-like symptoms.
"If you are poor or a minority, you are at higher risk for asthma," Kercsmar said. "The percentage we found suffering undue asthmatic morbidity was triple the national average."
The researchers then tried to determine the role indoor environment and quality of health care played in the urban asthma sufferer's life.
Factors in Urban Asthma |
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Kercsmar went into 660 homes collecting dust samples from the living rooms, kitchens and master bedrooms. Analysis of the dust samples revealed that a high percentage of households contained high antigen levels. Eighty-five percent of the homes contained cockroach and dust mite antigens, and 60% contained cat antigens. The cockroach antigens were found to be the biggest asthmatic trigger, she said.
"Cockroach antigen was a much bigger asthma trigger than the dust mite and cat antigens. Children who lived in these homes had more symptomatic days, more sleepless nights and more school days missed. Parents also suffered indirectly because they had to continually change plans due to their children's asthma severity," she said.
Ethnic differences also surfaced. Hispanic children were more likely to be troubled by cockroach antigens than black children, but at the same time appeared to be more resistant to dust mite antigens.
Many of the schools the minority children attended were found to be havens for asthma antigens. For example, of the several hundred samples taken from four inner-city Baltimore schools, almost 70% of them had detectable cockroach antigens. Most of the schools showed clear evidence of roach manifestation, as well as high levels of cat and dust mite antigens.
Researchers concluded that the reasons for the high percentage of indoor pollution were high humidity and poor ventilation in the classrooms, as well as various antigens brought in from the children's homes on their clothing and book bags. In addition, it was discovered that 40% of the school kids were exposed to second-hand smoke in their homes, with black children more likely to be exposed than Hispanic children, Kercsmar said.
Obtaining quality health care was also an issue in minority communities. Transportation problems, long waits for appointments and the availability of their own doctors were just some of the barriers urban residents complained to Kercsmar and her researchers about.
"Of the children we medically evaluated, 284 were found to exhibit the most severe asthma. They were highly symptomatic, used medication extensively and were constantly being rushed to the clinic for asthma-related complications," Kercsmar said, adding that 25% of the children in the study reported using no medication to alleviate their asthma in the last three months.
An "environmental intervention" was then initiated that included two visits from a professional exterminator, instruction from asthma counselors on how to clean areas that could attract cockroaches, the proper use of pillow and mattress covers, and referrals to smoking-cessation programs for those parents who were heavy smokers. A follow-up study two years later revealed a decrease in symptom days and severe asthma among the environmental intervention group, Kercsmar said.
"The problems with asthma in the inner city are interdimensional," Kercsmar said. "The quality of health care seems to be remiss for most of these children, and they will need some upgrading through interventions directly with health care providers and by teaching families more problem solving through asthma treatment programs. Only by directly addressing the problem will it eventually be solved."
For more information:
- Kercsmar CM. Issues in inner city asthma: ethnicity, economics and education. Presented at the American Thoracic Society's International Conference. May 16-21. San Francisco.
- Martinez F. The Natural history of asthma from childhood to adolescence. Presented at the American Thoracic Society's International Conference. May 16-21. San Francisco.
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