Risk Factors Accounting for Neighborhood Differences in Asthma Prevalence

导致哮喘患病率存在​​邻里差异的风险因素

• 批准号: 7650098
• 负责人: MATTHEW S PERZANOWSKI
• 金额: $ 66.24万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-30 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7650098
• 关键词: 7 year old; Accident and Emergency department; Accounting; Address; Age; Air; Allergens; Allergic; Asthma; Birth; Body mass index; Child; Childhood Asthma; Classification; Code; Communities; Consent; Cross-Sectional Studies; Data; Databases; Diagnosis; Dictyoptera; Dust; Employment; Enrollment; Ensure; Environment; Environmental Exposure; Ethnic Origin; Evaluation; Exhalation; Exposure to; General Population; Health; Health Insurance; Health Planning; Health Services Accessibility; High Prevalence; Home environment; Home visitation; Hospitalization; House Call; Income; Individual; Life; Link; Low Prevalence; Low income; Measures; Medical; Mental Health; Methods; Multivariate Analysis; Mus; Neighborhoods; New York; New York City; Nitric Oxide; Obesity; Outcome; Overweight; Parents; Particulate; Particulate Matter; Pharmaceutical Preparations; Physical activity; Population; Population Sizes; Prevalence; Provider; Questionnaires; Records; Recruitment Activity; Reporting; Research Personnel; Risk; Risk Factors; Sampling; Severities; Source; Spirometry; Surveys; Symptoms; Telephone; Telephone Interviews; Testing; United States; Variant; Visit; airway inflammation; asthma inhaler; base; cockroach allergen; environmental allergy; health care service utilization; inner city; member; programs; sedentary; sex

DESCRIPTION (provided by applicant): The prevalence of asthma varies among communities in the United States. Within New York City (NYC), the reported prevalence of pediatric asthma and hospitalization rates for asthma vary markedly between adjacent neighborhoods. We hypothesize that the difference in the prevalence of asthma observed between neighborhoods in NYC is due to differences in exposure to asthma/allergy environmental triggers (indoor cockroach and mouse allergens, and local sources of diesel particulates), physical activity levels and high body mass index for age. To test this hypothesis, we propose to recruit 800 children age 7 years who reside in NYC and have been enrolled in the HIP health plan through a parent or guardian's employment since birth. The children will be recruited from two types of neighborhoods of approximately equal HIP population size, 1) high asthma prevalence (~16%) neighborhoods [HAPN] 2) lower asthma prevalence (~9%) neighborhoods [LAPN]. Children will be classified as asthmatic or non-asthmatic by telephone administration of the ISAAC survey plus report of asthma controller medication. Employing stratified quota sampling we will recruit an equal number of asthmatics (n=400) and randomly selected non-asthmatics (n=400) enrolled from the combined population of HAPN and LAPN children. The HIP sampling frame will yield a multi-ethnic sample of children from low- middle and middle income homes, all of whom have similar access to health care. We will include measures on SES, ethnicity and built environment in multivariate analyses to control for these potential confounders. This study will use the same measures that are being employed in three other asthma studies being conducted on children the same age who live neighborhoods of high asthma prevalence in NYC. Aim 1. We hypothesize that, compared to children living in LAPN; children living in HAPN will be 1a.) More exposed to cockroach and mouse allergens in the dust and to diesel particulate matter in the air, 1b.) More likely to be sensitized to cockroach and mouse allergens, and 1c.) More sedentary and have a higher body mass index for age. Aim 2. We hypothesize that among children with asthma in LAPN, children with asthma in HAPN will have 2a.) More severe asthma (as classified by symptoms and spirometry), 2b.) higher levels of exhaled nitric oxide, a measure of airway inflammation. Aim 3. We hypothesize that among children sensitized to at least one allergen (i.e., atopic), those who live in a HAPN will be more likely to have asthma than those who live in an LAPN.

描述（由申请人提供）：美国各个社区的哮喘患病率各不相同。在纽约市 (NYC) 内，报告的儿童哮喘患病率和哮喘住院率在相邻社区之间存在显着差异。我们假设，纽约市各社区之间观察到的哮喘患病率的差异是由于接触哮喘/过敏环境触发因素（室内蟑螂和小鼠过敏原，以及当地柴油颗粒源）、体力活动水平和高年龄体重指数的差异造成的。为了检验这一假设，我们建议招募 800 名 7 岁儿童，他们居住在纽约市，并且自出生以来就通过父母或监护人的工作加入了 HIP 健康计划。这些儿童将从两类 HIP 人口规模大致相等的社区中招募：1) 哮喘患病率高 (~16%) 的社区 [HAPN] 2) 哮喘患病率较低 (~9%) 的社区 [LAPN]。通过电话管理 ISAAC 调查以及哮喘控制药物报告，将儿童分为哮喘或非哮喘。采用分层配额抽样，我们将从 HAPN 和 LAPN 儿童的合并人群中招募同等数量的哮喘患者 (n=400) 和随机选择的非哮喘患者 (n=400)。 HIP 抽样框架将产生来自中低收入家庭的儿童的多种族样本，他们都享有类似的医疗保健服务。我们将在多变量分析中纳入社会经济地位、种族和建筑环境的衡量标准，以控制这些潜在的混杂因素。这项研究将使用与其他三项哮喘研究相同的措施，这些研究对居住在纽约市哮喘高发区的同龄儿童进行。目标 1. 我们假设，与生活在 LAPN 的儿童相比；居住在 HAPN 的儿童将是 1a.) 更多地接触灰尘中的蟑螂和老鼠过敏原以及空气中的柴油颗粒物，1b.) 更有可能对蟑螂和老鼠过敏原敏感，以及 1c.) 更久坐，并且与年龄相比体重指数更高。目标 2. 我们假设 LAPN 的哮喘儿童中，HAPN 的哮喘儿童将出现 2a.) 更严重的哮喘（根据症状和肺活量测定进行分类），2b.) 呼出一氧化氮（气道炎症的一种衡量指标）水平更高。目标 3。我们假设，在对至少一种过敏原（即特应性）敏感的儿童中，居住在 HAPN 中的儿童比居住在 LAPN 中的儿童更容易患哮喘。