142nd APHA Annual Meeting and Exposition

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Neck Circumference Predicts Racial Disparities in Asthma Severity among Patients in a Comprehensive Pediatric Center

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 12:45 PM - 1:00 PM

Laurens Holmes Jr., MD, DrPH , Office of Health Equity & Inclusion, Nemours Healthcare System, Wilmington, DE
Kristen Juhrden, Student Researcher , DeSales University, Center Valley, PA
Robin Brennan, DrPH , Nemours Health and Prevention Services, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE
George Datto , Nemours Weight Management Clinic, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE
Alexandra LaHurd, Research Assistant , Department of Biological Sciences, University of Delaware, Newark, DE
Marlon Satchell , Nemours Health and Prevention Services, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE
Pat Oceanic , Office of Health Equity and Inclusion, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE
Kirk Dabney , Office of Health Equity and Inclusion, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE
Audio (mp3) recording Recorded Presentation (mp4)
Introduction:Uncontrollable asthma is most prevalent among racial/ethnic minorities and remains a public health challenge.  This study aimed to examine the neck circumference (NC) phenomenon as the biological determinant of racial variance in asthma severity.

Methods:A retrospective analysis of prospectively collected data on 583 children with asthma 0-19 years between 2007-2014 examined race, ethnicity, age, pulmonary functions, anthropomorphic measures, and socioeconomic factors.  A multivariable unconditional logistic regression model was used to assess the data.

Results:There were 30.4% whites, 55.2% blacks, 14.4% others, 88.0% non-Hispanics/Latinos, and 12.0% Hispanics/Latinos.  Relative to whites (mean=34.1cm + 4.74), blacks had higher NC (mean=39.7cm + 3.56).  Additionally, relative to non-Hispanics (mean=32.4cm + 4.34), Hispanics had higher NC (mean=35.8cm + 5.25).  Asthma was most severe among blacks (n=48, 14.9%) compared to whites (n=11, 6.2%).  Compared to non-Hispanics (n=7, 10.8%), asthma was most severe among Hispanics (n=65, 12.7%).  Neck circumference correlated directly with asthma severity, p<0.0001.  Neck circumference was highest among children with severe asthma (38.5cm + 4.95) relative to those with mild (34.4cm + 5.25) or moderate (34.5cm + 4.81) presentations.  Finally, for every 1 cm decrease in NC, there was an insignificant 16% reduction in asthma severity, odds ratio [OR]=0.84, 95% CI=0.60-1.18, p=0.30.

Discussion & Conclusion: Neck circumference may predispose to asthma severity due to the compromisation of cardiopulmonary functions.  Blacks and Hispanics were more likely, relative to whites, to have higher NC which explains the observed racial disparities in asthma severity.  These preliminary data indicate the relationship between asthma severity, NC, and racial differences.

Learning Areas:

Assessment of individual and community needs for health education
Epidemiology

Learning Objectives:
Assess the prevalence of asthma severity and excess neck circumference among children Examine the relationship between asthma severity and race/ethnicity Determine whether asthma severity is explained by neck circumference

Keyword(s): Asthma, Obesity

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I'm well trained in internal medicine and public health specifically epidemiology and biostatistics. Currently, I'm a professor of Molecular Epidemiology at the University of Delaware. I conceptualized the study, facilitated data collection, analyzed the data, interpreted the results, and addressed the discussion and conclusion. Very importantly, I directed the preparation of the manuscript, which is on its final phase for submission for concentration for publication by a reputable peer review scientific journal.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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