Risk Factors Accounting for Neighborhood Differences in Asthma Prevalence

哮喘的患病率在美国各社区之间存在差异。纽约市内 (NYC)，报告的儿童哮喘患病率和哮喘住院率各不相同 尤其是在相邻的街区之间。我们假设， 在纽约市的社区之间观察到的哮喘患病率是由于 暴露于哮喘/过敏环境触发物（室内蟑螂和小鼠过敏原， 及本地柴油微粒来源）、体力活动水平及高体重指数 年龄。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 并已通过父母或监护人的就业参加HIP健康计划，自 出生这些孩子将从两种类型的社区招募， 人口规模，1）高哮喘患病率（~16%）社区[HAPN] 2）低哮喘 患病率（~9%）社区[LAPN]。儿童将被分类为哮喘或非哮喘 通过电话管理ISAAC调查加上哮喘控制药物报告。 采用分层配额抽样，我们将招募相同数量的哮喘患者（n=400）， 随机选择的非哮喘患者（n=400）从HAPN和 LAPN儿童。HIP抽样框架将产生一个来自低收入国家的多种族儿童样本， 中等和中等收入家庭，他们都有类似的医疗保健。我们将 包括对社会经济地位、种族和建筑环境进行多变量分析， 这些潜在的混淆因素。本研究将使用与在 另外三项哮喘研究是在同一年龄的儿童中进行的， 纽约市哮喘发病率高。目标1。我们假设，与生活在LAPN的儿童相比， 生活在HAPN的儿童将是1a。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.）对蟑螂和老鼠更敏感 过敏原，和1c.）久坐不动的人更多，相对于年龄来说，体重指数更高。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（如通过症状和肺量测定法分类的），2b.）呼出的高浓度氮 氧化物，一种衡量气道炎症的指标。目标3：我们假设，在对 至少一种过敏原（即，特应性），那些生活在HAPN中的人比那些生活在HAPN中的人更容易患哮喘。 住在LAPN的人。

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 HIPsampling 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.