Individual and Neighborhood-Level Factors in Predicting Asthma

Saha, Chandan; Riner, Mary E.; Liu, Gilbert

doi:10.1001/archpedi.159.8.759

Cited by 50 publications

(31 citation statements)

References 17 publications

(15 reference statements)

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“…4 In addition to adversely affecting lung function and creating a condition of chronic inflammation, obesity is associated with several comorbidities, such as GER and OSA, which can worsen asthma. 30,[43][44][45][46][47] Urban environments further complicate the picture because they increase exposure to pollutants and allergens, which may contribute to asthma, but also increase exposure to risk factors for obesity such as availability of fast food and fewer parks. [48][49][50] Because obesity appears to be associated with increased risk of ED visits in urban children admitted with asthma, it is possible that interventions to decrease obesity can improve asthma outcomes.…”

Section: Discussionmentioning

confidence: 99%

Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus

Aragona

El-Magbri

Wang

et al. 2016

Hospital Pediatrics

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A B S T R A C T BACKGROUND AND OBJECTIVE:The prevalence of both childhood asthma and obesity remain at historically high levels and disproportionately affect urban children. Asthma is a common and costly cause for pediatric hospitalization. Our objective was to determine the effect of obesity on outcomes among urban children hospitalized with status asthmaticus. METHODS:A retrospective cohort study was performed by using billing system data and chart review to evaluate urban children admitted for asthma. Demographics, asthma severity, reported comorbidities, and outcomes were assessed. Obesity was defined by BMI percentile (lean ,85%, overweight 85%-95%, obese $95%). Outcomes were length of stay, hospitalization charges, ICU stay, repeat admissions, and subsequent emergency department (ED) visits. Bivariate analysis assessed for differences between overweight/obese and lean children. Multivariable regression assessed the relationship between overweight status and primary outcomes while controlling for other variables. Post hoc age-stratified analysis was also performed. RESULTS:The study included 333 subjects; 38% were overweight/obese. Overweight/obese children admitted with asthma were more likely than lean children to have subsequent ED visits (odds ratio 1.6, 95% confidence interval 1.0-2.6). When stratified by age, overweight/obese preschool-age children (,5 years) were .2 times as likely to have repeat ED visits than lean preschool-age children (odds ratio 2.3, 95% confidence interval 1.0-5.6). There were no differences in the other outcomes between overweight/obese and lean individuals within the entire cohort or within other age groups.

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Section: Discussionmentioning

confidence: 99%

Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus

Aragona

El-Magbri

Wang

et al. 2016

Hospital Pediatrics

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show abstract

“…Obese children are more likely to have increased risk factors for cardiovascular diseases, including elevations of blood pressure, cholesterol, lipids, and C-reactive protein [8,9]. Type 2 diabetes mellitus is also increased in obese children, and an association exists between childhood obesity and asthma with body mass index being a significant predictor of childhood asthma [10][11][12]. Fatty liver and cholecystitis are of increased incidence and prevalence in obese children [13,14].…”

Section: Discussionmentioning

confidence: 99%

Weight gain associated with chronic exposure to chlorpyrifos in rats

Meggs

Brewer

2007

J. Med. Toxicol.

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Objective: This work exposed rats to low levels of the organophosphate insecticide chlorpyrifos and monitored for toxic effects, including weight gain.Methods: Rats received either a subcutaneous injection of chlorpyrifos, 5 mg/kg/day, or an equal volume of vehicle daily for 4 months. Subjects were observed for 30 minutes after injection for signs of acute toxicity. Body weights were recorded at baseline, 2 months, 3 months, and 4 months. At the end of the experiment, the weights of hearts, medial lobe of the livers, peri-nephric fat pads, and gastrocnemius muscles were recorded. Effects of chlorpyrifos on adipocyte differentiation in culture were studied. Results were compared using RMANOVA.Results: No signs of acute cholinergic toxicity were observed after injections in any subject. Rats in the 5 mg/kg group were significantly heavier than those in the control group by 2 months (335.7 Ϯ 16.7 g vs. 318.6 Ϯ 15.8 g; p ϭ 0.034). This difference increased at 3 months (350.1 Ϯ 16.4 g vs. 322.3 Ϯ 21.3 g p ϭ 0.006) and 4 months (374.4 Ϯ 22.2 g vs. 340.2 Ϯ 25.2 g p ϭ 0.006). At 4 months, the weights of the perinephric fat pads were significantly increased in the chlorpyrifos group relative to controls (2.867 ϩ 0.516 vs. 1.130 ϩ 0.171, p ϭ 0.0039). The two groups showed no weight differences between hearts, livers, and gastrocnemius muscles. Chlorpyrifos did not affect adipocyte differentiation in tissue culture.Conclusions: Chronic exposure to chlorpyrifos at 5 mg/kg/day caused an increase in rat body weight when compared to controls. This increase was in adipose tissue. Chlorpyrifos did not induce differentiation of adipocytes in culture.

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“…2,[4][5][6][7][8] Studies conducted among populations of urban children have explored correlates of childhood asthma in efforts to identify the different levels at which social, psychological, and physical factors in the urban environment increase children's risk for asthma. Parent's race, 9,10 child's gender, 9,10 poverty, insurance status, 11 housing conditions, 10,12,13 and indoor allergen exposures [14][15][16] have all been associated with asthma in children, and some studies have also linked neighborhood level socioeconomic or housing characteristics to asthma. 11,17 Because there are very few published studies which include individual, immediate housing, and neighborhood level data in the same model, questions still remain as to whether characteristics of the neighborhood environment contribute directly to the development and exacerbation of asthma, or whether they are only representative of unmeasured characteristics more proximal to the individual.…”

Section: Introductionmentioning

confidence: 99%

Individual, Housing, and Neighborhood Correlates of Asthma among Young Urban Children

2012

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Using data from a large cohort of urban children, this study identified multilevel correlates of asthma to determine whether neighborhood attributes remain associated with asthma after adjustment for individual level and immediate housing characteristics. A cross-sectional analysis was conducted using data from the Fragile Families and Child Well-being Study and its substudy, the In-Home Longitudinal Study of Pre-Schooled Age Children (n=1,784). The primary outcome was asthma diagnosis by age 5. Sociodemographic measures were assessed via telephone survey, housing and block conditions recorded via direct observation, and neighborhood characteristics came from geocoded census tract data. After multivariable adjustment, non-Hispanic Black, Puerto Rican, or other Hispanic race, child's lack of insurance coverage, male gender, presence of allergies, the exterior condition of a child's home, mother's educational attainment, and the percent of the neighborhood population with a bachelor's degree remained significantly associated with having received an asthma diagnosis by age 5. The authors identified sociodemographic and economic factors at the individual, household, and neighborhood level which are correlates of childhood asthma in urban areas. After adjustment for more proximal characteristics, the effects of all neighborhood markers were minimal, with the exception of neighborhood education.

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Individual and Neighborhood-Level Factors in Predicting Asthma

Cited by 50 publications

References 17 publications

Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus

Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus

Weight gain associated with chronic exposure to chlorpyrifos in rats

Individual, Housing, and Neighborhood Correlates of Asthma among Young Urban Children

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