Abstract
OBJECTIVES: To establish rates of childhood asthma symptoms, diagnosis, and hospitalization by race, ethnicity, and income, and to ascertain if elevated reported prevalence of asthma diagnosis among African-American children could be explained by differences in clinical findings. METHODS: Estimates of each indicator were calculated based on data from the third National Health and Nutrition and Examination Survey (NHANES III). Bivariate and multivariate logistic regression models were estimated to predict parent or guardian report of current asthma diagnosis. RESULTS: African-American children aged 1 to 5 have a 2-fold higher probability of both asthma diagnosis and hospitalization during the previous year but no significant difference in wheeze prevalence compared to Mexican-American and European-American children. These differences are not explained by household income or clinical information. Children aged 6 to 16 had similar rates of diagnosis and hospitalization for all racial/ethnic groups, although African-American children reported wheeze symptoms one-third less often. CONCLUSIONS: Although younger African-American children have higher morbidity from asthma than their Mexican-American and European-American peers, clinical findings were similar and did not explain increased rates of diagnosis. Interpersonal dynamics within families and communication between families and clinicians are believed to influence both symptom reporting and diagnosis generation.
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- Aligne C. A., Auinger P., Byrd R. S., Weitzman M. Risk factors for pediatric asthma. Contributions of poverty, race, and urban residence. Am J Respir Crit Care Med. 2000 Sep;162(3 Pt 1):873–877. doi: 10.1164/ajrccm.162.3.9908085. [DOI] [PubMed] [Google Scholar]
- Bloomberg G. R., Strunk R. C. Crisis in asthma care. Pediatr Clin North Am. 1992 Dec;39(6):1225–1241. doi: 10.1016/s0031-3955(16)38442-5. [DOI] [PubMed] [Google Scholar]
- Carter-Pokras O. D., Gergen P. J. Reported asthma among Puerto Rican, Mexican-American, and Cuban children, 1982 through 1984. Am J Public Health. 1993 Apr;83(4):580–582. doi: 10.2105/ajph.83.4.580. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Centers for Disease Control and Prevention (CDC) Asthma mortality and hospitalization among children and young adults--United States, 1980-1993. MMWR Morb Mortal Wkly Rep. 1996 May 3;45(17):350–353. [PubMed] [Google Scholar]
- Crain E. F., Weiss K. B., Bijur P. E., Hersh M., Westbrook L., Stein R. E. An estimate of the prevalence of asthma and wheezing among inner-city children. Pediatrics. 1994 Sep;94(3):356–362. [PubMed] [Google Scholar]
- Cunningham J., Dockery D. W., Speizer F. E. Race, asthma, and persistent wheeze in Philadelphia schoolchildren. Am J Public Health. 1996 Oct;86(10):1406–1409. doi: 10.2105/ajph.86.10.1406. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Donahue J. G., Weiss S. T., Livingston J. M., Goetsch M. A., Greineder D. K., Platt R. Inhaled steroids and the risk of hospitalization for asthma. JAMA. 1997 Mar 19;277(11):887–891. [PubMed] [Google Scholar]
- Ernst P., Demissie K., Joseph L., Locher U., Becklake M. R. Socioeconomic status and indicators of asthma in children. Am J Respir Crit Care Med. 1995 Aug;152(2):570–575. doi: 10.1164/ajrccm.152.2.7633709. [DOI] [PubMed] [Google Scholar]
- Finkelstein J. A., Barton M. B., Donahue J. G., Algatt-Bergstrom P., Markson L. E., Platt R. Comparing asthma care for Medicaid and non-Medicaid children in a health maintenance organization. Arch Pediatr Adolesc Med. 2000 Jun;154(6):563–568. doi: 10.1001/archpedi.154.6.563. [DOI] [PubMed] [Google Scholar]
- Gergen P. Social class and asthma--distinguishing between the disease and the diagnosis. Am J Public Health. 1996 Oct;86(10):1361–1362. doi: 10.2105/ajph.86.10.1361. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Guarnaccia P. J., Pelto P. J., Schensul S. L. Family health culture, ethnicity, and asthma: coping with illness. Med Anthropol. 1985 Summer;9(3):203–224. doi: 10.1080/01459740.1985.9965933. [DOI] [PubMed] [Google Scholar]
- Halterman J. S., Aligne C. A., Auinger P., McBride J. T., Szilagyi P. G. Inadequate therapy for asthma among children in the United States. Pediatrics. 2000 Jan;105(1 Pt 3):272–276. [PubMed] [Google Scholar]
- Miller J. E. The effects of race/ethnicity and income on early childhood asthma prevalence and health care use. Am J Public Health. 2000 Mar;90(3):428–430. doi: 10.2105/ajph.90.3.428. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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]
- Targonski P. V., Persky V. W., Orris P., Addington W. Trends in asthma mortality among African Americans and whites in Chicago, 1968 through 1991. Am J Public Health. 1994 Nov;84(11):1830–1833. doi: 10.2105/ajph.84.11.1830. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tobacco: promises are not enough. Lancet. 1997 Jul 5;350(9070):1–1. [PubMed] [Google Scholar]
- Weiss K. B., Gergen P. J., Crain E. F. Inner-city asthma. The epidemiology of an emerging US public health concern. Chest. 1992 Jun;101(6 Suppl):362S–367S. doi: 10.1378/chest.101.6.362s. [DOI] [PubMed] [Google Scholar]
- Werk L. N., Steinbach S., Adams W. G., Bauchner H. Beliefs about diagnosing asthma in young children. Pediatrics. 2000 Mar;105(3 Pt 1):585–590. doi: 10.1542/peds.105.3.585. [DOI] [PubMed] [Google Scholar]