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"Trends in Racial Disparities for Asthma Outcomes among Children 0 to 17 Years, 2001-2010."

Authors: Akinbami, Lara J., MD, Jeanne E. Moorman, MS, Alan E. Simon, MD, and Kenneth C. Schoendorf, MD

Journal of Allergy and Clinical Immunology, Volume 134.3 (2014), 547-553

View the full article here: http://www.jacionline.org/article/S0091-6749(14)00798-2/fulltext

Abstract:
Background –
Racial disparities in childhood asthma have been a long-standing target for intervention, especially disparities in hospitalization and mortality.

Objectives –
Describe trends in racial disparities in asthma outcomes using both traditional population-based rates and at-risk rates (based on the estimated number of children with asthma) to account for prevalence differences between race groups.

Methods –
Estimates of asthma prevalence and outcomes (emergency department [ED] visits, hospitalizations, and deaths) were calculated from national data for 2001 to 2010 for black and white children. Trends were calculated using weighted loglinear regression, and changes in racial disparities over time were assessed using Joinpoint.

Results –
Disparities in asthma prevalence between black and white children increased from 2001 to 2010; at the end of this period, black children were twice as likely as white children to have asthma. Population-based rates showed that disparities in asthma outcomes remained stable (ED visits and hospitalizations) or increased (asthma attack prevalence, deaths). In contrast, analysis with at-risk rates, which account for differences in asthma prevalence, showed that disparities in asthma outcomes remained stable (deaths), decreased (ED visits, hospitalizations), or did not exist (asthma attack prevalence).

Conclusions –
Using at-risk rates to assess racial disparities in asthma outcomes accounts for prevalence differences between black and white children, and adds another perspective to the population-based examination of asthma disparities. An at-risk rate analysis shows that among children with asthma, there is no disparity for asthma attack prevalence and that progress has been made in decreasing disparities in asthma ED visit and hospitalization rates.

This tool kit is intended for organizations who want to start a new asthma home visit program or add to an existing program. It includes descriptions of each visit, pilot program data, lessons learned, successes, and more. The forms provided in the appendix of tools are for public use and can be edited to fit different organization’s needs. The guidance provided in this tool kit is not intended to replace comprehensive training prior to providing home visiting services to the public. 

The tools and information in this guidance will help keep the air clean where many Americans spend up to 90 percent of their time – indoors.  Some of the biggest threats to indoor air quality stem from moisture issues. Leaking roofs, plumbing problems, condensation issues, poor indoor humidity control, and lack of drainage around the base of buildings are  some of the commonly reported causes of moisture problems in the United States.  These problems can not only threaten the structural integrity of buildings, they can also increase exposure to mold and other biological contaminants. Such exposure is associated with increases in the occurrence and severity of allergies, asthma and other respiratory illnesses.