Pediatric Asthma Health Disparities: Race, Hardship, Housing, and Asthma in a National Survey

• Published in: Academic pediatrics 2017-03, Vol.17 (2), p.127-134
• Main Authors: Hughes, Helen K., MD, MPH, Matsui, Elizabeth C., MD, MHS, Tschudy, Megan M., MD, MPH, Pollack, Craig E., MD, MHS, Keet, Corinne A., MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Asian - statistics & numerical data; asthma; Asthma - epidemiology; Black or African American - statistics & numerical data; Child; Educational Status; Emergency Service, Hospital - statistics & numerical data; Ethnicity - statistics & numerical data; Family Characteristics; Female; health care disparities; Health Status Disparities; Hispanic or Latino - statistics & numerical data; housing; Housing - statistics & numerical data; Humans; Income - statistics & numerical data; Logistic Models; Male; Middle Aged; Neonatal and Perinatal Medicine; Odds Ratio; Ownership - statistics & numerical data; Pediatrics; poverty; United States; White People - statistics & numerical data; Young Adult
• ISSN: 1876-2859; 1876-2867
• DOI: 10.1016/j.acap.2016.11.011

Abstract Objective We sought to determine if racial disparities in pediatric asthma are explained by material hardship and home ownership. Methods We performed a secondary analysis of the 2011 American Housing Survey. A total of 33,201 households with children age 6 to 17 years were surveyed regarding childhood asthma diagnosis and emergency department (ED) visits for asthma (for the youngest child with asthma in the household). Material hardship included poor housing quality, housing crowding, lack of amenities, and no vehicle access. We used logistic regression to determine the association between race, material hardship, and asthma diagnosis or ED visits, adjusting for potential confounders. Results Non-Hispanic black heads of household had a higher odds of having a child diagnosed with asthma in the home compared with non-Hispanic white heads of household (odds ratio, 1.72; 95% confidence interval [CI], 1.50–1.96), and a higher odds of ED visits for asthma (odds ratio, 3.02; 95% CI, 2.29–3.99). The race–asthma association was decreased but not eliminated after adjusting for material hardship and home ownership (ED visit adjusted odds ratio [AOR], 2.07; 95% CI, 1.50–2.86). Poor housing quality was independently associated with asthma diagnosis (AOR, 1.45; 95% CI, 1.28–1.66) and ED visits (AOR, 1.59; 95% CI, 1.21–2.10). Home ownership was associated with a lower odds of asthma-related ED visits (AOR, 0.62; 95% CI, 0.46–0.84). Conclusions Observed racial disparities in pediatric asthma are lessened after controlling for material hardship. Poor housing quality in particular is strongly associated with asthma morbidity. Policy makers could target improving housing quality as a means of potentially reducing asthma disparities.