Disparities in allergy testing and health outcomes among urban children with asthma
Received 20 November 2007; received in revised form 31 July 2008; accepted 4 August 2008.
Background
Previous research has found that treating allergies and reducing exposure to allergens can reduce asthma morbidity.
Objective
We sought to examine whether urban asthmatic children were receiving care for allergies as part of a comprehensive asthma management plan.
Methods
A cross-sectional study, consisting of a parent-reported questionnaire, was conducted in 26 randomly selected New York City public elementary schools during the 2002-2003 school year.
Results
In a sample of 5250 children aged 5 to 12 years, 13.0% were found to have current asthma. The prevalence of allergy diagnosis was 21.0%. Less than half (47.3%) of the subjects with current asthma reported a physician's diagnosis of allergies. The frequency of a reported allergy diagnosis varied with race/ethnicity, ranging from 14.4% in Mexican American children to 67.9% in white children. Only 54.9% of asthmatic children with an allergy diagnosis reported allergy testing. Children from lower-/middle-income households and children with public forms of health insurance were the least likely to report testing (adjusted odds ratios, 0.18 and 0.46). Higher frequencies of reported allergy testing were associated with education on allergen avoidance, use of allergy medications, lower exposure to household allergens, and lower prevalence of wheezing.
Conclusions
Many children do not receive comprehensive asthma treatment that includes management of allergies and education on avoidance of household allergens. Lower reported allergy testing might indicate lower access to medical care among middle-income families who are ineligible for public programs but who do not have the income to access higher-quality care. Interventions aimed at improving medical care and adherence to treatment guidelines are necessary to decrease asthma morbidity.
Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY
Reprint requests: Luz Claudio, PhD, One Gustave Levy Place, Box 1057, New York, NY 10029.
Supported by the New York State Assembly through SEARCH and by a supplement grant to the Mount Sinai Center for Children's Environmental Health and Disease Prevention (EPA Region 2, grant R827039).
Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.
ABSTRACT