Contribution of Residential Exposures to Asthma in US Children and Adolescents

Abstract

ABSTRACT. Context. Residential exposures are recognized risk factors for asthma, but the relative contribution of specific indoor allergens and their overall contribution to asthma among older children and adolescents in the United States are unknown.Objective. To estimate the relative contributions, population-attributable risks, and costs of residential risk factors for doctor-diagnosed asthma.Design. Nationally representative, cross-sectional survey conducted from 1988 to 1994.Setting and Participants. A total of 5384 children who were 6 to 16 years old and participated in the National Health and Nutrition Examination Survey III, a survey of the health and nutritional status of children and adults in the United States.Main Outcome Measure. Doctor-diagnosed asthma, as reported by the parent.Results. Five hundred three of 5384 children and adolescents (11.4%) had doctor-diagnosed asthma. After adjusting for age, gender, race, urban status, region of country, educational attainment of the head of household, and poverty, predictors of doctor-diagnosed asthma included a history of allergy to a pet (odds ratio [OR: 2.4; 95% confidence interval [CI]: 1.7, 3.3), presence of a pet in the household (OR: 1.5; 95% CI: 1.1, 2.1), and immediate hypersensitivity to dust mite (OR: 1.5; 95% CI: 1.05, 2.0), Alternaria (OR: 1.9; 95% CI: 1.3, 2.8), and cockroach allergens (OR: 1.4; CI: 1.04, 1.9). Family history of atopy (OR: 1.7; 95% CI: 1.1, 2.7) and diagnosis of allergic rhinitis (OR: 2.1; CI: 1.1, 3.7) were also predictors for asthma. The population-attributable risk of having 1 or more residential exposures associated with doctor-diagnosed asthma was 44.4% (95% CI: 29 -60), or an estimated 2 million excess cases. The attributable cost of asthma resulting from residential exposures was $405 million (95% CI: $264 -$547 million) annually.Conclusions. 4 -20 Studies that have implicated certain risk factors for asthma, however, are often limited by small sample size or a restricted focus on a specific age group, geographic distribution, or socioeconomic strata. 4,10,17,21 Thus, the relative contribution of specific allergens or other residential exposures to asthma for children and adolescents in the United States is poorly defined. Moreover, there has not been any attempt to estimate the overall contribution of indoor allergens or residential exposures to asthma. To develop a national strategy to prevent childhood asthma, it is critical to estimate the contribution of specific risk factors and the overall contribution of residential exposures to asthma.In a previous analysis, we estimated that residential exposures-including pets in the household, allergy to a pet, exposure to environmental tobacco smoke, and use of gas stove or oven for heat-accounted for 530 000 excess cases (40%) of doctordiagnosed asthma in children Ͻ6 years old. 20 Risk factors for asthma in early childhood, however, are often distinct from those that predict asthma in later childhood and adolescence. 6,9 Moreover, skin testing was not conducted among ch...

Allergen Sensitization Profiles in a Population-Based Cohort of Children Hospitalized for Asthma

“…The inpatient setting may be a good opportunity to pursue serum-specific IgE testing given that outpatient follow-up does not always occur. There are verified links between allergen sensitization and exposure and both diagnosis of asthma (35) and asthma morbidity (12,15). Although we saw trends toward associations between allergen sensitization and risk of rehospitalization, and severity of hospital course, relationships mostly did not meet statistical significance.…”

Are Building-Level Characteristics Associated with Indoor Allergens in the Household?

“…40,41 Such triggers include household environmental exposures, high parental stress, poor medication adherence, child behavioral or emotional concerns, and poor medical care. 3,16,21,22,[24][25][26][42][43][44][45][46][47] An emerging literature does suggest that indoor allergens associated with asthma are related to the buildings in which people live. 10,11,[48][49][50][51][52] Considerable literature firmly establishes that the presence of cockroaches and rodents (i.e., pests) is associated with higher levels of asthma morbidity.…”

Some Epidemiological Aspects of Bronchial Asthma in Children in Qena Governorate, Egypt

“…Georgy et al [36] in a study of prevalence and socioeconomic associations of asthma and allergic rhinitis in Egypt found a higher prevalence and increased severity of asthma symptoms in children of lower socio-economic groups. Children from lower socioeconomic status are at greater risk for asthma as well as adverse asthma-related events, such as hospitalizations.…”

“…Children from lower socioeconomic status are at greater risk for asthma as well as adverse asthma-related events, such as hospitalizations. This may be explained by greater exposure to allergens, reduced access to care, and gene by environment interactions [36]. Recently, psychosocial factors and stress in low income families, in particular, has been suggested to be an important contributor to asthma [37].…”