Study: Asthma Hits Poor Minorities Worst in California

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Asthma rates are on the rise in California, but the condition disproportionately affects low-income children and adults, according to a study [PDF] from the UCLA Center for Health Policy Research.

With 4.9 million Californians suffering from the respiratory condition, researchers felt an urgent need to better understand the contributors to the asthma disparity. So they looked at data from the 2007 California Health Interview Survey to determine whether and how differences in income were associated with asthma diagnosis and treatment. (More on Study: The Complicated Link Between Wealth and Obesity)

Throughout the state, rates of asthma had increased 13% overall between 2001 and 2007. The highest rates of asthma were found in lower-income inland areas, such as Fresno, where 12.9% of residents reported the respiratory disorder, and where the bottom-of-the-basin location means poorer air quality. Meanwhile, in wealthy, coastal, breezy San Francisco, asthma affected only 6% of residents — the lowest rate in the state.

Researchers also found that rates of secondhand smoke exposure — a known trigger for asthma — were three times higher among poor sufferers of the disease than in wealthy ones. Indeed, secondhand smoke exposure is exceedingly common in apartment-dwelling children, as Healthland’s Alice Park reported recently: a study found that at least 96% of children living in multi-unit residences had chemical byproducts of tobacco in their blood, even though they lived in nonsmoking homes; the exposure was likely due to smoking neighbors in nearby apartments. (More on How Group Drumming May Improve Low-Income Student Behavior)

The burden of asthma hits poor kids harder too. The UCLA study found that low-income children with asthma missed twice as many days of school per year due to asthma attacks than higher-income children (2.8 vs. 1.3 days). Low-income adults with asthma also had an absence problem, missing three times as many work days as higher-income adults each year.

Researchers have long known that asthma disproportionately affects the poor. Of the many factors that contribute to the disparity, one is known as environmental racism. Poorer communities, which tend to house minority groups, are more likely to be closer to environmental pollutants like industry waste, and are less likely to have mitigating features like trees and parks, compared with wealthier neighborhoods.

“As a black person in America, I am twice as likely as a white person to live in an area where air pollution poses the greatest risk to my health,” said Majora Carter, who is currently the president of the Majora Carter Group and an advocate for sustainable development in urban areas, during a TED talk in February 2006. “I’m five times as likely to live within walking distance of a power plant.” (More on The Rich Are Different: More Money, Less Empathy)

Further, asthma in low-income adults and children tends to be more problematic than in their wealthier counterparts: the UCLA study found that in low-income households, 23.9% of children had gone to an emergency room for care within the past year, compared with 12.5% of children in wealthy homes. Data for adults were similar: 18.8% of low-income adults visited an ER, while only 8.8% of wealthier adults did the same.

The researchers speculate that because low-income asthma sufferers are less likely to have health insurance and receive less consistent care — they often do not have a regular doctor and are less likely to have an asthma management plan — they require more emergency care than higher-income people with the disease. While 22.1% of low-income asthma sufferers are uninsured, only 4.4% of middle-class and wealthy Californians with asthma lack health insurance.

“To reduce the overall burden of asthma among low-income Californians, policies and interventions are needed to improve living conditions and environments for low-income Californians,” wrote the study’s authors. “Public policies and private efforts to reduce exposures to indoor and outdoor asthma triggers, to prevent exposures to smoke and chemicals, to prohibit smoking indoors and in public spaces, and to discourage children and adults from smoking can help create asthma-friendly environments.”

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