A comparison of asthma prevalence and morbidity between rural and urban schoolchildren in Arkansas

Pesek, Robbie D.; Vargas, Perla A.; Halterman, Jill S.; Jones, Stacie M.; McCracken, Andy; Perry, Tamara T.

doi:10.1016/j.anai.2009.11.038

Cited by 54 publications

(25 citation statements)

References 23 publications

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“…13–14, 20 Of these, one report used state surveillance data on asthma ED visits and therefore offers no data on prevalence 14 , and another was a non-peer reviewed work group report. 20 This report 20 analyzed Behavioral Risk Factor Surveillance System data, and found a national prevalence of self-reported asthma in urban areas of 12% versus 11% in rural areas (N=264,684, p<0.001).…”

Section: Discussionmentioning

confidence: 99%

“…12 A comparison of rural and urban schoolchildren in Arkansas revealed similar asthma prevalence by residence, but increased prevalence of symptoms of uncontrolled asthma among the rural children. 13 An analysis of hospital discharge information from Mississippi found an increased rate of emergency department care and hospitalization for asthma among residents of the rural Mississippi delta compared with metropolitan Jackson, and this difference persisted after controlling for covariates. 14 …”

Section: Introductionmentioning

confidence: 99%

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High asthma prevalence and increased morbidity among rural children in a Medicaid cohort

Valet

Gebretsadik

Carroll

et al. 2011

Annals of Allergy, Asthma & Immunology

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Background Urban children represent a group at high risk for asthma development and adverse asthma outcomes. Although rural children also encounter sociodemographic disparities that might be expected to worsen asthma, asthma in the rural US is poorly studied. Objectives To determine rural-urban differences in childhood asthma diagnosis and morbidity. Methods We studied a statewide population of 117,080 children continuously enrolled in Tennessee Medicaid from birth through the sixth year of life, using linked Tennessee Medicaid, vital records, and pharmacy claims databases to determine asthma diagnosis and residence. Results The cohort was 45% urban, 23% suburban, and 33% rural. Compared with urban children, rural children were more likely to be white, have a history of bronchiolitis, and have mothers who smoked. Eleven percent of urban, 12% of suburban, and 13% of rural children met study criteria for asthma diagnosis (adjusted odds ratio [OR] for rural children 1.16, 95% confidence interval [CI] 1.09–1.24, and for suburban children adjusted OR 1.22, 95% CI 1.14–1.30, with urban as referent, P<0.001). Rural children had greater utilization of outpatient asthma care, whereas urban children had greater utilization of inhaled corticosteroids. Compared with urban children, rural children had fewer asthma ED visits, but were hospitalized for asthma at similar rates. Others markers of asthma control, including oral corticosteroid and short acting beta agonist usage, were similar between rural and urban children. CONCLUSION In this pediatric Medicaid population, rural children had increased asthma prevalence, similar asthma morbidity, and differences in patterns of asthma care and resource utilization compared with urban children.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High asthma prevalence and increased morbidity among rural children in a Medicaid cohort

Valet

Gebretsadik

Carroll

et al. 2011

Annals of Allergy, Asthma & Immunology

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“…Some researchers believe that wheeze in children < 5 years constitutes reactive airways, though NHLBI does not include a lower age limit for diagnosing asthma ("National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma," 2007). To date, most asthma disparities research has focused on urban children (Pesek et al, 2010). The degree to which asthma expression differs between urban and rural children remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…The degree to which asthma expression differs between urban and rural children remains controversial. The “hygiene hypothesis” suggests that early exposure to higher levels of microbes in rural children (e.g, exposure to farm animals) may be protective, while other studies report that rates of asthma may be similar for rural and urban children and that asthma severity actually may be greater for rural children (Frei et al, 2014; Pesek et al, 2010). Thus, while recruitment from rural populations limits generalizability, a strength of this study is that it uses information from an understudied yet potentially vulnerable population of children.…”

Section: Discussionmentioning

confidence: 99%

Maternal intimate partner violence exposure, child cortisol reactivity and child asthma

Bair-Merritt¹,

Voegtline²,

Ghazarian³

et al. 2015

Child Abuse & Neglect

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Psychosocial stressors like intimate partner violence (IPV) exposure are associated with increased risk of childhood asthma. Longitudinal studies have not investigated the role of hypothalamic-pituitary-adrenal (HPA) axis reactivity (and associated alterations in cortisol relsease) in the child IPV exposure-asthma association. We sought to investigate this association, and to assess whether this relationship differs by child HPA reactivity. This secondary analysis used longitudinal cohort data from the Family Life Project. Participants included 1292 low-income children and mothers; maternal interview and child biomarker data, including maternal report of IPV and child asthma, and child salivary cortisol obtained with validated stress reactivity paradigms, were collected when the child was 7, 15, 24, 35, and 48 months. Using structural equation modeling, maternal IPV when the child was 7 months of age predicted subsequent reports of childhood asthma (B = 0.18, p = .002). This association differed according to the child’s HPA reactivity status, with IPV exposed children who were HPA reactors at 7 and 15 months of age -- defined as a ≥ 10% increase in cortisol level twenty minutes post peak arousal during the challenge tasks and a raw increase of at least .02 ug/dl -- being significantly at risk for asthma (7 months: B = 0.17, p = .02; 15 months: B = 0.17, p = .02). Our findings provide support that children who are physiologically reactive are the most vulnerable to adverse health outcomes when faced with environmental stressors.

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“…However few investigators have directed their attention to asthma in rural AA populations of similar socioeconomic status. 1;3;5;14;15 This is in spite of the fact that 19.3% of the population lives in rural areas of the United States according to the 2010 census.…”

Section: Introductionmentioning

confidence: 99%

Comparison of asthma prevalence among African American teenage youth attending public high schools in rural Georgia and urban Detroit

Ownby

Tingen

Havstad

et al. 2015

Journal of Allergy and Clinical Immunology

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Background The high prevalence of asthma among urban African American (AA) populations has attracted research attention while the prevalence among rural AA populations is poorly documented. Objective To compare the prevalence of asthma among AA youth in rural Georgia and urban Detroit, Michigan. Methods The prevalence of asthma was compared in population-based samples of 7297 youth attending Detroit public high schools and in 2523 youth attending public high schools in rural Georgia. Current asthma was defined as a physician diagnosis and symptoms in the previous 12 months. Undiagnosed asthma was defined as multiple respiratory symptoms in the previous 12 months without a physician diagnosis. Results In Detroit, 6994 (95.8%) youth were AA compared to 1514 (60.0%) in GA. Average population density in high school ZIP codes was 5628 people/mi2 in Detroit and 45.1 people/mi2 in GA. The percent of poverty and of students qualifying for free or reduced lunches were similar in both areas. The prevalence of current diagnosed asthma among AA youth in Detroit and GA were similar: 15.0% (95% CI 14.1–15.8), and 13.7% (CI 12.0–17.1) (p=.22), respectively. Undiagnosed asthma prevalence in AA youth was 8.0% in Detroit and 7.5% in GA (p=.56). Asthma symptoms were reported more frequently among those with diagnosed asthma in Detroit while those with undiagnosed asthma in Georgia reported more symptoms. Conclusions Among AA youth living in similar socioeconomic circumstances, asthma prevalence is as high in rural Georgia as it is in urban Detroit suggesting that urban residence is not an asthma risk factor. Clinical Implications Asthma prevalence was as common among African American high school students in rural Georgia as among students in urban Detroit, Michigan. Asthma is more likely related to poverty than urban residence.

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A comparison of asthma prevalence and morbidity between rural and urban schoolchildren in Arkansas

Cited by 54 publications

References 23 publications

High asthma prevalence and increased morbidity among rural children in a Medicaid cohort

High asthma prevalence and increased morbidity among rural children in a Medicaid cohort

Maternal intimate partner violence exposure, child cortisol reactivity and child asthma

Comparison of asthma prevalence among African American teenage youth attending public high schools in rural Georgia and urban Detroit

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