Social Determinants of Asthma in American Indian Children

BACKGROUND

American Indian (AI) / Alaska Native (AN) children have a higher asthma prevalence than white children in the U.S. (9.4% versus 7.7%, respectively). The AI/AN population is extremely diverse; demographic, lifestyle, genetic, and environmental factors influence asthma prevalence and severity in these communities. Our study sought to examine risk factors associated with asthma among children in an American Indian community, and to describe risk factors and differences in clinical course between asthmatic cases on a controller medication versus those not on a controller.

METHODS

This is a case-control study of children with physician-diagnosed asthma and age-matched controls, ages 6 through 17 years, in an American Indian community. Diagnosis and clinical characteristics were obtained from medical record review. Home study visits included interviews, asthma control and quality of life questionnaires, and physical exam.

RESULTS

Among the 108 asthmatic cases and 215 controls, 64% had an annual household income <$25,000, of which 39% were <$10,000. Lower annual household income level (p=0.04), type of housing (multi-unit dwelling versus single-occupancy residence, p=0.04), and home infestation of rodents or insects (p=0.01) were positively associated with asthma. Children with asthma had significantly higher odds of atopy, food allergies, and history of RSV infection than controls. A large proportion of both cases and controls reported persistent respiratory symptoms, though the prevalence was significantly higher among cases: cough (48 vs 14%, OR 19.0, 95%CI: 9.1-41.4), wheeze (53 vs 5%, OR 5.6, 95%CI: 3.2-10.1), and dyspnea (49 vs 6%, OR 14.2, 95%C: 6.9-30.2).

CONCLUSION

In this low-income AI community, we identified several social determinants of asthma, including lower income and suboptimal housing conditions. Many children with asthma reported persistent cough, wheeze, and dyspnea, indicators of poorly controlled asthma. The prevalence of chronic respiratory symptoms reported by controls merits further investigation to identify and potentially treat unrecognized lung disease in AI children.