Population Disparities in Asthma

Harvard Medical School, Channing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts 02467, USA.
Annual Review of Public Health (Impact Factor: 6.47). 02/2005; 26(1):89-113. DOI: 10.1146/annurev.publhealth.26.021304.144528
Source: PubMed


The prevalence of asthma in the United States is higher than in many other countries in the world. Asthma, the most common chronic disease of childhood in the United States, disproportionately burdens many socioeconomically disadvantaged urban communities. In this review we discuss hypotheses for between-country disparities in asthma prevalence, including differences in "hygiene" (e.g., family size, use of day care, early-life respiratory infection exposures, endotoxin and other farm-related exposures, microbial colonization of the infant bowel, exposure to parasites, and exposure to large domestic animal sources of allergen), diet, traffic pollution, and cigarette smoking. We present data on socioeconomic and ethnic disparities in asthma prevalence and morbidity in the United States and discuss environmental factors contributing to asthma disparities (e.g., housing conditions, indoor environmental exposures including allergens, traffic air pollution, disparities in treatment and access to care, and cigarette smoking). We discuss environmental influences on somatic growth (low birth weight, prematurity, and obesity) and their relevance to asthma disparities. The relevance of the hygiene hypothesis to the U.S. urban situation is reviewed. Finally, we discuss community-level factors contributing to asthma disparities.

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    • "Some children have mild attacks and others have severe life threatening attacks. Asthma attacks are usually triggered by a wide variety of things, including allergens (e.g., cockroaches, dust mites, pollen, etc.), exercise, changes in weather, air pollutants (e.g., tobacco smoke), stress, infections, diet, and obesity [6] [7] [8]. In 2007, 13.1% of children (9.6 million) had, at some time during their lives, a diagnosis of asthma and 9.1% (6.7 million) currently had asthma [9]. "
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    ABSTRACT: Racial/ethnic minorities are 1.5 to 2.0 times more likely than whites to have most of the major chronic diseases. Chronic diseases are also more common in the poor than the nonpoor and this association is frequently mediated by race/ethnicity. Specifically, children are disproportionately affected by racial/ethnic health disparities. Between 1960 and 2005 the percentage of children with a chronic disease in the United States almost quadrupled with racial/ethnic minority youth having higher likelihood for these diseases. The most common major chronic diseases of youth in the United States are asthma, diabetes mellitus, obesity, hypertension, dental disease, attention-deficit/hyperactivity disorder, mental illness, cancers, sickle-cell anemia, cystic fibrosis, and a variety of genetic and other birth defects. This review will focus on the psychosocial rather than biological factors that play important roles in the etiology and subsequent solutions to these health disparities because they should be avoidable and they are inherently unjust. Finally, this review examines access to health services by focusing on health insurance and dental insurance coverage and access to school health services.
    BioMed Research International 09/2013; 2013:787616. DOI:10.1155/2013/787616 · 3.17 Impact Factor
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    • "Inspite of parallel immune response, epidemiological studies show that the prevalence of allergic diseases and helminthiasis are inversely associated. Allergic diseases are increasing in industrialized countries and more prevalent in urban areas [2, 3], while helminth infections are decreasing in industrialized countries yet widespread in rural areas and developing countries [4]. "
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    ABSTRACT: Common antigens between intestinal parasites and environmental allergens may play a role in the modulation of allergic immune responses. There is a growing interest in investigating cross-reactivity between common helminths and dust mites affecting humans, particularly in the tropics. This study examined the cross-reactivity between the human roundworm Ascaris lumbricoides (Al) and three house dust mite (HDM) species. Specific serum IgE levels to HDM species Blomia tropicalis (Bt), Dermatophagoides pteronyssinus (Dp), and Dermatophagoides farinae (Df ); and Al extracts among allergic (n=100) and ascariasis (n=60) subjects were measured through enzyme-linked immunosorbent assay (ELISA). IgE-reactive components of HDM and Al extracts were detected through Western-Blot Analysis. Cross-reactivity between HDMs and Al was determined by ELISA inhibition using HDM and Al-specific sera from allergic (n=15) and ascariasis (n=15) subjects. The IgE-binding capacity of a recombinant paramyosin peptide (Blo t 11-fD) to allergic (n=50) and ascariasis (n=50) subjects' sera were likewise determined. Among allergic subjects, 70% exhibited Al-specific positive IgE-reactivity, while 20-28% of ascariasis subjects demonstrated HDM-specific positive IgE-reactivity. Multiple IgE-reactive components of HDM allergens (14-240 kDa) and Al antigens (15-250 kDa) were detected, indicating multi-allergen sensitization among the subjects tested. Al antigens can inhibit up to 92% of HDM-specific IgE-reactivity among allergic subjects, while up to 54% of Al-specific IgE-reactivity among ascariasis subjects was inhibited by HDM allergens. Positive rBlo t 11-fD-specific IgE reactivity was observed in 80% of the allergic subjects and 46% of the ascariasis subjects. This study showed the presence of multiple cross-reactive antigens in HDM and Al extracts. Identification of these molecules may provide basis for designing novel diagnostic and therapeutic strategies. The potential role of paramyosin as a specific cross-reactive allergen present in HDMs and Al has been shown.
    01/2012; 2(1):35-44. DOI:10.5415/apallergy.2012.2.1.35
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    • "INTRODUCTION (Gold and Wright 2005 "
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    ABSTRACT: Alarming disparities in population health and wellness in the United States have led to multidisciplinary research efforts to create health equity. Identifying disparities, elucidating the etiological bases of disparities, and implementing solutions to eliminate disparities are part of the U.S. national health agenda. Racial and ethnic disparities have been identified throughout the cancer control continuum, in cardiovascular disease, diabetes and a multitude of other conditions. The causes of disparities are complex, condition specific, and conjectured to result from combinations of biological and socio-behavioral factors. Racial and ethnic health disparities within the vast incarcerated communities have been excluded from most studies, yet are of significant ethical and fiscal concern to inmates, governing bodies, and non-incarcerated communities into which inmates return. Importantly, research on racial and ethnic disparities in this unique population may shed light on the relative etiologies of health disparities and solutions for creating health equity throughout the general population in the United States.
    01/2012; 5(2):92-100.
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