The protective effect of community factors on childhood asthma
Received 22 April 2008; received in revised form 26 March 2009; accepted 30 March 2009. published online 18 May 2009.
Background
Asthma burden in the US is not evenly distributed. Although asthma prevalence varies widely across urban neighborhoods, little attention has been paid to the community as a key contributor.
Objective
To determine the effect of positive socio-environmental community factors on childhood asthma prevalence in Chicago.
Methods
From 2003 to 2005, an asthma screening survey was conducted among children attending Chicago Public/Catholic schools from kindergarten through eighth grade. One hundred five schools participated, yielding a stratified representation of 4 race-income groups. Positive community factors, such as social capital, economic potential, and community amenities, were assessed by using the Metro Chicago Information Center's Community Vitality Index.
Results
Of the surveys returned, 45,177 (92%) were geocoded into 287 neighborhoods. Neighborhoods were divided into quartile groups by asthma prevalence (mean, 8%, 12%, 17%, 25%). Community vitality (54% vs 44%; P < .0001) and economic potential (64% vs 38%; P < .0001) were significantly higher in neighborhoods with low asthma prevalence. Neighborhood interaction (36% vs 73%; P < .0001) and stability (40% vs 53%; P < .0001) were significantly higher in neighborhoods with high asthma prevalence. Overall, positive factors explained 21% of asthma variation. Childhood asthma increased as the black population increased in a community (P < .0001). Accordingly, race/ethnicity was controlled. In black neighborhoods, these factors remained significantly higher in neighborhoods with low asthma prevalence. When considered alongside socio-demographic/individual characteristics, overall community vitality as well as social capital continued to contribute significantly to asthma variation.
Conclusion
Asthma prevalence in Chicago is strongly associated with socio-environmental factors thought to enrich a community. A deeper understanding of this impact may lend insight into interventions to reduce childhood asthma.
dRobert Graham Center: Policy Studies in Family Medicine and Primary Care, American Academy of Family Physicians, Washington, DC
eDepartment of Medicine, Section on Health Promotion, University of Illinois at Chicago, Chicago, Ill
fDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Cook County Hospital, Chicago, Ill
gCenter for the Management of Complex Chronic Care, US Department of Veterans Affairs, Edward Hines, Jr VA Hospital, Hines, Ill
Reprint requests: Ruchi S. Gupta, Children's Memorial Hospital, 2300 Children's Plaza, Box 157, Chicago, IL 60614.
Supported by National Heart, Lung, and Blood Institute grant 5U01 HL072478-05 and National Institute of Child Health and Human Development grant K12 HD052902.
Disclosure of potential conflict of interest: J. J. Shannon has received research support from the National Heart, Lung, and Blood Institute. The rest of the authors have declared that they have no conflict of interest.
ABSTRACT