Risk Factors Accounting for Neighborhood Differences in Asthma Prevalence

描述（由申请人提供）：美国不同社区的哮喘患病率各不相同。在纽约市（NYC），报告的儿童哮喘患病率和哮喘住院率在邻近社区之间差异显著。我们假设，纽约市不同社区之间观察到的哮喘患病率差异是由于暴露于哮喘/过敏环境触发因素（室内蟑螂和老鼠过敏原，以及当地柴油颗粒来源）、身体活动水平和年龄高体重指数的差异。为了验证这一假设，我们建议招募800名居住在纽约市的7岁儿童，并且自出生以来通过父母或监护人的就业参加了HIP健康计划。儿童将从两种类型的HIP人口规模大致相等的社区招募，1)高哮喘患病率（~16%）社区[HAPN] 2)低哮喘患病率（~9%）社区[LAPN]。通过ISAAC调查的电话管理和哮喘控制药物的报告，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相同数量的哮喘患者（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和中等收入家庭的多种族儿童样本，他们都有类似的保健机会。我们将在多变量分析中纳入社会经济地位、种族和建筑环境的措施，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，这些研究正在对居住在纽约市哮喘高患病率社区的同龄儿童进行。目的1。我们假设，与生活在LAPN的孩子相比；生活在HAPN的孩子将是1岁。更多地暴露于灰尘中的蟑螂和老鼠过敏原以及空气中的柴油颗粒物质。更容易对蟑螂和老鼠的过敏原过敏，1c。)久坐时间越长，身体质量指数越高。目标2。我们假设在LAPN的哮喘儿童中，HAPN的哮喘儿童将有2a。)更严重的哮喘（根据症状和肺活量测定分类），2b)呼出的一氧化氮水平更高，一氧化氮是气道炎症的一种衡量标准。目标3。我们假设，在对至少一种过敏原（即特应性过敏原）敏感的儿童中，生活在HAPN的儿童比生活在LAPN的儿童更容易患哮喘。

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.