Prevalence, Demographics, and Health Outcomes of Comorbid Asthma and Overweight in Urban Children

Abstract

Background. Asthma and overweight are epidemic in urban children but the relationship between these conditions is not fully understood. This study presents demographic and risk profiles of comorbidity for overweight asthmatic children, characterizes morbidity by comparing health outcomes among overweight asthmatics and healthy weight asthmatics, and examines socioeconomic factors associated with comorbidity. Objective. To construct a demographic profile of overweight asthmatic children in an urban setting and identify factors that contribute to prevalence. Method. Cross-sectional study of 5250 children in New York City public elementary schools using a parent-report questionnaire on body mass index, socioeconomic status, asthma, and asthma-related outcomes. Results. Prevalence of overweight (body mass index ≥ 85th percentile for age and gender) was 50.9%. The prevalence of overweight and ever being diagnosed with asthma was 10.9%. The prevalence of overweight with current asthma was 6.2%. Overweight current asthmatics had more night symptoms, missed school days, and asthma medication use than healthy weight asthmatics. Almost 50% of overweight current asthmatic children reported emergency department visits for asthma compared with 30% of healthy weight asthmatics. Comorbidity was most prevalent among males, Latinos, and children in low-income households, with the highest prevalence among Puerto Ricans. In multivariate analysis stratified by gender, the most significant factors associated with comorbidity among girls were low income and minority race/ethnicity, while among boys significant factors were parental education and parental history of asthma. Interestingly, there were few underweight children (7.8%) but they had high prevalence of asthma (13.8%). Conclusions. The comorbidity of overweight and asthma has a large impact on urban populations, causing greater disease burden than asthma alone. Overweight asthmatics show more uncontrolled asthma, evidenced by emergency department visits, quick-relief medication use, and days with asthma symptoms. The relationship between socioeconomic factors and the asthma–obesity comorbidity may vary by gender and requires further study to identify successful interventions to reduce disease in children.

Keywords:

• asthma
• child
• health status disparities
• minority health
• obesity
• overweight
• schools

Acknowledgments

The authors extend thanks to the principals, teachers, parents, and children of NYC who participated in this project. The authors thank Dr. Maida Galvez for her review of this manuscript. This work was supported by grants to the Mount Sinai Center for Children’s Environmental Health and Disease prevention (grants from NIEHS/EPA Children’s Center ES 09584 and R837039, ES/CA 12770). Additional support for Dr. Claudio’s work was provided by the Environmental Justice and Healthy Communities Program of the Ford Foundation. Additional support for Ms. Stingone’s work was provided by NICHD T32 HD052468.

Declaration of Interest

The authors report no conflicts of interest and have no financial disclosure to declare. The authors alone are responsible for the content and writing of the paper.