Skip to main content
Environmental Health Perspectives logoLink to Environmental Health Perspectives
. 2002 Apr;110(Suppl 2):211–216. doi: 10.1289/ehp.02110s2211

Different slopes for different folks: socioeconomic and racial/ethnic disparities in asthma and hay fever among 173,859 U.S. men and women.

Jarvis T Chen 1, Nancy Krieger 1, Stephen K Van Den Eeden 1, Charles P Quesenberry 1
PMCID: PMC1241165  PMID: 11929730

Abstract

Although allergic diseases such as asthma and hay fever are a major cause of morbidity in industrialized countries, most studies have focused on patterns of prevalence among children and adolescents, with relatively few studies on variations in prevalence by race/ethnicity and socioeconomic position among adults. Our study examined racial/ethnic and socioeconomic patterns in the prevalence of asthma overall, asthma with hay fever, asthma without hay fever, and hay fever overall, in a population of 173,859 women and men in a large prepaid health plan in northern California. Using education as a measure of socioeconomic position, we found evidence of a positive gradient for asthma with hay fever with increasing level of education but an inverse gradient for asthma without hay fever. Hay fever was also strongly associated with education. Compared with their White counterparts, Black women and men were more likely to report asthma without hay fever, and Black women were less likely to have asthma with hay fever. Asian men were also more likely to report asthma with hay fever, and Asian women and men were much more likely to have hay fever. Racial/ethnic disparities in prevalence of allergic diseases were largely independent of education. We discuss implications for understanding these social inequalities in allergic disease risk in relation to possible differences in exposure to allergens and determinants of immunologic susceptibility and suggest directions for future research.

Full Text

The Full Text of this article is available as a PDF (520.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson H. R., Pottier A. C., Strachan D. P. Asthma from birth to age 23: incidence and relation to prior and concurrent atopic disease. Thorax. 1992 Jul;47(7):537–542. doi: 10.1136/thx.47.7.537. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bergmann R. L., Edenharter G., Bergmann K. E., Lau S., Wahn U. Socioeconomic status is a risk factor for allergy in parents but not in their children. Clin Exp Allergy. 2000 Dec;30(12):1740–1745. doi: 10.1046/j.1365-2222.2000.00927.x. [DOI] [PubMed] [Google Scholar]
  3. Burrows B., Martinez F. D., Halonen M., Barbee R. A., Cline M. G. Association of asthma with serum IgE levels and skin-test reactivity to allergens. N Engl J Med. 1989 Feb 2;320(5):271–277. doi: 10.1056/NEJM198902023200502. [DOI] [PubMed] [Google Scholar]
  4. Ferrari M., Tardivo S., Zanolin M. E., Olivieri M., Lampronti G., Biasin C., Poli A., Balestreri F., de Marco R., Lo Cascio V. Serious childhood respiratory infections and asthma in adult life. A population based study. ECRHS Italy. European Community Respiratory Health Survey. Ann Allergy Asthma Immunol. 1999 Nov;83(5):391–396. doi: 10.1016/s1081-1206(10)62836-0. [DOI] [PubMed] [Google Scholar]
  5. Fleming D. M., Crombie D. L. Prevalence of asthma and hay fever in England and Wales. Br Med J (Clin Res Ed) 1987 Jan 31;294(6567):279–283. doi: 10.1136/bmj.294.6567.279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Forastiere F., Agabiti N., Corbo G. M., Dell'Orco V., Porta D., Pistelli R., Levenstein S., Perucci C. A. Socioeconomic status, number of siblings, and respiratory infections in early life as determinants of atopy in children. Epidemiology. 1997 Sep;8(5):566–570. doi: 10.1097/00001648-199709000-00015. [DOI] [PubMed] [Google Scholar]
  7. Gergen P. J., Mullally D. I., Evans R., 3rd National survey of prevalence of asthma among children in the United States, 1976 to 1980. Pediatrics. 1988 Jan;81(1):1–7. [PubMed] [Google Scholar]
  8. Kay A. B. Allergy and allergic diseases. First of two parts. N Engl J Med. 2001 Jan 4;344(1):30–37. doi: 10.1056/NEJM200101043440106. [DOI] [PubMed] [Google Scholar]
  9. Kemp T., Pearce N., Fitzharris P., Crane J., Fergusson D., St George I., Wickens K., Beasley R. Is infant immunization a risk factor for childhood asthma or allergy? Epidemiology. 1997 Nov;8(6):678–680. doi: 10.1097/00001648-199710000-00011. [DOI] [PubMed] [Google Scholar]
  10. Kitch B. T., Chew G., Burge H. A., Muilenberg M. L., Weiss S. T., Platts-Mills T. A., O'Connor G., Gold D. R. Socioeconomic predictors of high allergen levels in homes in the greater Boston area. Environ Health Perspect. 2000 Apr;108(4):301–307. doi: 10.1289/ehp.00108301. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Klatsky A. L., Friedman G. D., Siegelaub A. B., Gérard M. J. Alcohol consumption among white, black, or oriental men and women: Kaiser-Permanente multiphasic health examination data. Am J Epidemiol. 1977 Apr;105(4):311–323. doi: 10.1093/oxfordjournals.aje.a112388. [DOI] [PubMed] [Google Scholar]
  12. Krieger N. Theories for social epidemiology in the 21st century: an ecosocial perspective. Int J Epidemiol. 2001 Aug;30(4):668–677. doi: 10.1093/ije/30.4.668. [DOI] [PubMed] [Google Scholar]
  13. Leung R. C., Carlin J. B., Burdon J. G., Czarny D. Asthma, allergy and atopy in Asian immigrants in Melbourne. Med J Aust. 1994 Oct 3;161(7):418–425. doi: 10.5694/j.1326-5377.1994.tb127522.x. [DOI] [PubMed] [Google Scholar]
  14. Leung R. Asthma and migration. Respirology. 1996 Jun;1(2):123–126. doi: 10.1111/j.1440-1843.1996.tb00020.x. [DOI] [PubMed] [Google Scholar]
  15. Lewis S., Richards D., Bynner J., Butler N., Britton J. Prospective study of risk factors for early and persistent wheezing in childhood. Eur Respir J. 1995 Mar;8(3):349–356. doi: 10.1183/09031936.95.08030349. [DOI] [PubMed] [Google Scholar]
  16. Litonjua A. A., Carey V. J., Weiss S. T., Gold D. R. Race, socioeconomic factors, and area of residence are associated with asthma prevalence. Pediatr Pulmonol. 1999 Dec;28(6):394–401. doi: 10.1002/(sici)1099-0496(199912)28:6<394::aid-ppul2>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  17. Littlejohns P., Macdonald L. D. The relationship between severe asthma and social class. Respir Med. 1993 Feb;87(2):139–143. doi: 10.1016/0954-6111(93)90142-m. [DOI] [PubMed] [Google Scholar]
  18. Mitchell R. G., Dawson B. Educational and social characteristics of children with asthmna. Arch Dis Child. 1973 Jun;48(6):467–471. doi: 10.1136/adc.48.6.467. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Nilsson L., Björkstén B. Factors which promote or prevent allergy. Monogr Allergy. 1993;31:190–210. [PubMed] [Google Scholar]
  20. Power C., Matthews S. Origins of health inequalities in a national population sample. Lancet. 1997 Nov 29;350(9091):1584–1589. doi: 10.1016/S0140-6736(97)07474-6. [DOI] [PubMed] [Google Scholar]
  21. Salmond C., Crampton P., Hales S., Lewis S., Pearce N. Asthma prevalence and deprivation: a small area analysis. J Epidemiol Community Health. 1999 Aug;53(8):476–480. doi: 10.1136/jech.53.8.476. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Schwartz J., Gold D., Dockery D. W., Weiss S. T., Speizer F. E. Predictors of asthma and persistent wheeze in a national sample of children in the United States. Association with social class, perinatal events, and race. Am Rev Respir Dis. 1990 Sep;142(3):555–562. doi: 10.1164/ajrccm/142.3.555. [DOI] [PubMed] [Google Scholar]
  23. Shaheen S. O., Aaby P., Hall A. J., Barker D. J., Heyes C. B., Shiell A. W., Goudiaby A. Measles and atopy in Guinea-Bissau. Lancet. 1996 Jun 29;347(9018):1792–1796. doi: 10.1016/s0140-6736(96)91617-7. [DOI] [PubMed] [Google Scholar]
  24. Sly R. M. Changing prevalence of allergic rhinitis and asthma. Ann Allergy Asthma Immunol. 1999 Mar;82(3):233–252. doi: 10.1016/S1081-1206(10)62603-8. [DOI] [PubMed] [Google Scholar]
  25. Strachan D. P. Epidemiology of hay fever: towards a community diagnosis. Clin Exp Allergy. 1995 Apr;25(4):296–303. doi: 10.1111/j.1365-2222.1995.tb01046.x. [DOI] [PubMed] [Google Scholar]
  26. Strachan D. P. Hay fever, hygiene, and household size. BMJ. 1989 Nov 18;299(6710):1259–1260. doi: 10.1136/bmj.299.6710.1259. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Svanes C., Jarvis D., Chinn S., Burney P. Childhood environment and adult atopy: results from the European Community Respiratory Health Survey. J Allergy Clin Immunol. 1999 Mar;103(3 Pt 1):415–420. doi: 10.1016/s0091-6749(99)70465-3. [DOI] [PubMed] [Google Scholar]
  28. Upton M. N., McConnachie A., McSharry C., Hart C. L., Smith G. D., Gillis C. R., Watt G. C. Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring. BMJ. 2000 Jul 8;321(7253):88–92. doi: 10.1136/bmj.321.7253.88. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Weitzman M., Gortmaker S. L., Sobol A. M., Perrin J. M. Recent trends in the prevalence and severity of childhood asthma. JAMA. 1992 Nov 18;268(19):2673–2677. [PubMed] [Google Scholar]
  30. Weitzman M., Gortmaker S., Sobol A. Racial, social, and environmental risks for childhood asthma. Am J Dis Child. 1990 Nov;144(11):1189–1194. doi: 10.1001/archpedi.1990.02150350021016. [DOI] [PubMed] [Google Scholar]
  31. von Mutius E., Martinez F. D., Fritzsch C., Nicolai T., Reitmeir P., Thiemann H. H. Skin test reactivity and number of siblings. BMJ. 1994 Mar 12;308(6930):692–695. doi: 10.1136/bmj.308.6930.692. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Environmental Health Perspectives are provided here courtesy of National Institute of Environmental Health Sciences

RESOURCES