Socioeconomic status and asthma control in African American youth in SAGE II

Abstract

Objective: African Americans are disproportionately burdened by asthma. We assessed the individual and joint contribution of socioeconomic status (SES) on asthma morbidity among African American youth. Methods: We examined 686 African Americans (8–21 years) with asthma. To account for the joint effects of SES, a composite index was derived from maternal educational attainment, household income, and insurance status. Ordinal logistic regression was used to estimate the individual and joint effect of SES on asthma control. Models were adjusted for age, sex, controller medication use, in utero smoke exposure, family history of asthma, family history of rhinitis, breastfeeding, daycare attendance, and mold exposure. Results: Participants were classified as Poorly Controlled Asthma (40.8%), Partially Controlled Asthma (29.7%), or Controlled Asthma (30.2%). Of the individual SES indicators, low income was the strongest predictor of poor asthma control. Children with low income had worse asthma control than those with higher income (OR 1.39; 95% CI 0.92–2.12). The SES index ranged from 4–9. SES was associated with 17% increased odds of poor asthma control with each decrease in the index (95% CI 1.05–1.32). The SES index was associated with asthma-related symptoms, nocturnal awakenings, limited activity, and missed school days. Conclusions: The negative effects of SES were observed along the entire socioeconomic gradient, and the adverse asthma outcomes observed in African American youth were not limited to the very poor. We also found that the SES index may be a more consistent and useful predictor of poor asthma outcomes than each indicator alone.

• Education
• health status disparities
• income
• minority health
• youth

Acknowledgements

The authors acknowledge the families and patients for their participation and thank the numerous healthcare providers and community clinics for their support and participation in SAGE II. In particular, the authors thank the study coordinator Sandra Salazar and the recruiters who obtained the data: Lisa Caine, Elizabeth Castellanos, and Shahdad Saeedi.

Author contributions

N.T. was responsible for analyzing the data with supervision and input from L.N.B., K.B-D., L.A.R., S.S.O., S.S. and E.G.B. N.T. wrote the first version and all subsequent revisions of the manuscript. M.M. wrote components of the first version of the manuscript. E.C. assisted with subsequent drafts included in the manuscript. H.J.F, L.N.B., E.B-B., A.D., M.A.L., S.T., and E.G.B. planned and supervised the collection of data from the various recruitment regions in the initial cohort. N.T. and E.G.B. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors contributed to interpretation of results, and provided revisions and approval of the final manuscript.