Material Hardship and Indoor Allergen Exposure among Low-Income, Urban, Minority Children with Persistent Asthma

Abstract

Traditional measures of socioeconomic status (SES) are associated with asthma morbidity, but their specific contributions are unclear. Increased exposure to indoor allergens among low SES children is an important consideration. Material hardship, a concept describing poor access to basic goods and services, may explain the relationship between low SES and indoor allergen exposure, and thereby, the increased risk of asthma morbidity. We sought to (i) describe the specific hardships experienced by low-Income, urban, minority children with asthma and indoor allergen sensitization and (ii) determine if material hardship is associated with indoor allergen exposure in this population. We conducted a cross-sectional analysis of children undergoing the baseline assessment for a clinical trial of home environmental modification. Participants were scored in five domains of material hardship. Domain scores were assigned based on caregiver responses to a questionnaire and were summed to generate a total material hardship score. Linear regression was used to examine the relationship between material hardship scores and bedroom floor concentrations of five common indoor allergens. Participants experienced high levels of material hardship in each of the five domains, with 33% not having access to a car, 35% not being able to pay utility bills, and 28% not being able to pay rent in the past year. Each one-point increase in material hardship was associated with an increase in cockroach allergen of 16.2% (95% CI: 9.4%, 24.6%) and an increase in mouse allergen of 9.4% (95% CI: 1.0%, 18.5%). After adjusting for traditional measures of SES, including household income, health insurance type, caregiver education, and caregiver employment status, the association between material hardship and cockroach allergen, but not mouse allergen, remained. These data suggest that a significant proportion of families of low-income, minority children with asthma may experience material hardship, and that they may be at greater risk of cockroach allergen exposure than their peers with similar income, but without material hardship.

Association of Coffee and Tea Consumption with the Risk of Asthma: A Prospective Cohort Study from the UK Biobank

“…On the other hand, asthmatics could also be influenced by a wide variety of factors, including age [ 35 , 36 ], sex [ 37 ], BMI [ 38 , 39 ], and smoking status [ 40 ]. In addition to the factors previously discussed, educational background and Townsend deprivation index are socioeconomic factors that exert effects on environmental allergen exposure [ 41 , 42 ] and may lead to variations in coffee and tea consumption [ 43 , 44 ]. Similar to other studies [ 7 , 25 , 45 ], we adjusted for education and Townsend deprivation index in this study.…”

Disrupting links between poverty, chronic stress, and educational inequality

“…Over 12 million children in the United States live in poverty 1 , which can be defined as having resources below the average family that results in an inability to fully participate in society 2 . Children living in poverty may experience a plethora of disruptive life events and circumstances--for example, lower-quality prenatal care, economic strain, frequent moves, higher rates of illness, food insecurity, neighborhood violence, malnutrition and greater exposure to pollution and toxins [3][4][5][6] . Children in poverty are also more likely to be exposed to high levels of parental stress, increasing risk for negative parenting practices 7,8 .…”