Neighborhood poverty, urban residence, race/ethnicity, and asthma: Rethinking the inner-city asthma epidemic.

Although it is thought that inner-city areas have a high burden of asthma, the prevalence of asthma in inner-cities across the U.S. is not known. To estimate the prevalence of current asthma in U.S. children living in inner-city and non-inner city areas, and to examine whether urban residence, poverty or race/ethnicity are the main drivers of asthma disparities. The National Health Interview Survey 2009–2011 was linked by census tract to data from the U.S. Census and the National Center for Health Statistics. Multivariate logistic regression models adjusted for sex, age, race/ethnicity, residence in an urban, suburban, medium metro or small metro/rural area, poverty, and birth outside the U.S. with current asthma and asthma morbidity as outcome variables. Inner-city areas were defined as urban areas with ≥20% of households below the poverty line. 23,065 children living in 5,853 census tracts were included. The prevalence of current asthma was 12.9% in inner-city and 10.6% in non-inner-city areas, but this difference was not significant after adjusting for race/ethnicity, region, age and sex. In fully adjusted models, Black race, Puerto Rican ethnicity and lower household income, but not residence in poor or urban areas, were independent risk factors for current asthma. Household poverty increased the risk of asthma among non-Hispanics and Puerto Ricans but not among other Hispanics. Associations with asthma morbidity were very similar to prevalent asthma. Although the prevalence of asthma is high in some inner-city areas, this is largely explained by demographic factors and not by living in an urban neighborhood.

尽管人们认为市中心区域的哮喘负担较重，但美国各地市中心的哮喘患病率尚不明确。 为了估算居住在美国市中心和非市中心区域儿童的当前哮喘患病率，并检验城市居住环境、贫困状况或种族/民族是否是哮喘差异的主要驱动因素。 2009 - 2011年美国国家健康访问调查通过人口普查区与美国人口普查以及美国国家卫生统计中心的数据相关联。以性别、年龄、种族/民族、居住在城市、郊区、中等都市或小型都市/农村地区、贫困状况以及在美国境外出生为调整因素，以当前哮喘和哮喘发病率为结果变量构建多元逻辑回归模型。市中心区域被定义为贫困线以下家庭占比≥20%的城市区域。 研究纳入了居住在5853个人口普查区的23065名儿童。当前哮喘患病率在市中心区域为12.9%，在非市中心区域为10.6%，但在对种族/民族、地区、年龄和性别进行调整后，这种差异并不显著。在完全调整后的模型中，黑人种族、波多黎各族裔以及较低的家庭收入是当前哮喘的独立风险因素，而居住在贫困或城市地区则不是。家庭贫困增加了非西班牙裔和波多黎各人患哮喘的风险，但在其他西班牙裔人群中则没有。与哮喘发病率的关联与哮喘患病率非常相似。 尽管一些市中心区域的哮喘患病率较高，但这在很大程度上是由人口统计学因素而非居住在城市社区所导致的。