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339028
Racial Heterogeneity in the Relationship between Social Hardship, Violence and Asthma Severity in Children: Multilevel Analysis using NSCH, 2012


Wednesday, November 4, 2015 : 1:06 p.m. - 1:24 p.m.

Laurens Holmes Jr., MD, DrPH, Office of Health Equity & Inclusion, Nemours Healthcare System, Wilmington, DE
Isabel Morgan, BA, MSPH(c), Office of Health Equity and Inclusion, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE
Eryka Bradley, BS(c), Office of Health Equity and Inclusion, Nemours, Wilmington, DE
Patricia Oceanic, MS, CDM, Office of Health Equity and Inclusion, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE
Kirk Dabney, MD, MHCDS, Office of Health Equity and Inclusion, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE
Audio (mp3) recording Recorded Presentation (mp4)
Objective: Epidemiologic data continue to illustrate the disproportionate burden of asthma among racial minorities. We aimed to examine the prevalence of asthma severity, and to determine if racial variability is explained by exposure to social hardship and violence. 

Methods:Using a cross-sectional study we examined the contribution of social hardship, social disadvantage, and violence on the persisting racial disparities in childhood asthma severity. The National Survey of Children’s Health 2012 data were used. Asthma severity was classified as mild vs. moderate/severe. Data were assessed using survey multivariable logistic regression models.

Results:Of 95,677 households surveyed, 7,931 (8.6%) reported of a child being currently diagnosed with asthma. Of all those diagnosed with asthma, 25.9% presented with moderate/severe asthma. Racial differences were observed in asthma severity, white n= 1,170 (23.1%), black n= 493 (33.1%) and other n=367 (28.3%). Relative to children not exposed to violence, children exposed to violence were 44% more likely to have moderate/severe asthma, prevalence odds ratio (POR)= 1.44, 95% Confidence Interval (CI) 1.25-1.64. Similarly children with hardship were 54% more likely to be diagnosed with moderate/severe asthma, POR=1.54, 95% CI, 1.39-1.72. After controlling for confounders, psychological trauma as violence was associated with 42% increased likelihood of being diagnosed with moderate/severe asthma among blacks, adjusted prevalence odds ratio=1.42 95% CI 0.66-3.06. There was racial heterogeneity in the association between asthma severity and violence. In this relationship blacks were 37% more likely to have moderate/severe asthma given exposure to violence, POR=1.62, 95% CI 1.67-1.92.  After adjustment for prognostic factors and asthma severity risk markers, the relationship between asthma severity and race did persist between blacks and whites, APOR=1.28 99% CI = 1.03-1.60.

Conclusion: Black children relative to whites were disproportionately affected by asthma severity, while racial heterogeneity existed in the relationship between asthma severity and social hardship as well as violence, and was not removed after controlling for prognostic factors and risk markers. These data are indicative of the need to address social disadvantage, violence, and social hardship among racial minorities, mainly blacks in the U.S. in an attempt to reduce racial disparities in asthma severity among children.

Learning Areas:

Chronic disease management and prevention
Epidemiology
Provision of health care to the public
Public health or related public policy
Public health or related research

Learning Objectives:
Assess the relationship between asthma severity and psychological trauma among children. Examine racial heterogeneity in the relationship between asthma severity and psychological trauma Explain racial heterogeneity using multilevel analysis

Keyword(s): Health Disparities/Inequities, Chronic Disease Prevention

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: The primary author conceptualized the study and the design, analyzed the data, interpreted the results, prepared the manuscript and the final draft.
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.

Back to: 5150.0: Recent Findings in Health Disparities Research - Session 2