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Asthma Rates in New York City: What Do We Know About the Causes?
From: Columbia University
| By:
Jean Ford |
EDITOR'S INTRODUCTION |
Asthma is the most common chronic environmental lung disease in children. It is characterized by an abnormal immune response that affects the airways, that is, the bronchial tubes in the lungs. It usually manifests early in life, and recent research raises the possibility that sensitization may begin in utero. In New York City--home to the highest asthma rates in the country--the greatest rates of hospitalization for asthma occur in low-income communities of color.
 The Asthma Project of the Columbia Center for Children's Environmental Health (CCCEH) is currently studying the relationship between environmental exposures and asthma in African-American and Dominican children in northern Manhattan and the South Bronx. Jean Ford (right), Florence Irving Assistant Professor of Medicine at Columbia University and director of the Harlem Lung Center of Harlem Hospital, serves as the principal investigator of the Asthma Project. His project seeks to explain what factors in the environment in early life are causing increased vulnerability to asthma. |
 he prevalence of asthma is rising worldwide. In the United States, the rising asthma prevalence is particularly an urban phenomenon. New York City has the dubious distinction of having the highest rate of asthma mortality and some of the highest rates of asthma morbidity in the country. |
Within New York City, communities characterized by low incomes and populated predominantly by people of color have some of the highest rates of asthma. This has been shown dramatically in a number of studies. Most recently, a study by Luz Claudio, professor of community medicine at Mt. Sinai School of Medicine, showed a strong relationship between poverty and asthma throughout New York City. |
Communities in northern Manhattan and the South Bronx where people of color and low-income families live also show some of the highest rates of asthma. The Columbia Center for Children's Environmental Health is currently conducting a cohort study of 560 women and newborn babies drawn from these communities. I will tell you a little bit about some preliminary data from children in the first three months of life whose record of symptoms has been examined. |
Every three months, we administer a brief symptom questionnaire to the mothers in this study. Our research workers also bond with those mothers to really ascertain what has been happening. The data that I want to report on looks at the prevalence of asthma-like symptoms in children during the first three months of life. It has been prepared and looked at by Dr. Ilan Meyer, assistant professor of public health at Columbia University. |
Our interviews revealed that 40 percent of the children had experienced respiratory symptoms known to be associated with asthma. Twenty-five percent of the mothers reported unscheduled physician visits. Of that 25 percent, approximately 15 percent went to the emergency department and 7 percent of the children were actually hospitalized. |
Some parents of young children will say, "That's about the rate at which I worry about my own child." So we asked, "How does that compare with what's in other studies? Is this really special to our population?" We looked at published data from a US population-based publication from the Centers for Disease Control and Prevention (CDC). |
The CDC study reported a significantly lower prevalence of office visits in the age group 0-4. The methodologies differ in that we are questioning the mothers every three months. You can see, however, that a lot more office visits and significantly more emergency department visits occur in northern Manhattan in the first three months of life compared with what is reported for the first four years of life for the US population. |
A word of caution. If you look at the 0-to-3-year-old bracket, it is very clear that not all that wheezes is asthma. The majority of infants who are wheezing during that period are "transient early wheezers." According to Rachel Miller, assistant professor of clinical medicine at Columbia University, some infants are sensitized in utero to specific allergens. Fernando Martinez, professor of pediatrics at the University of Arizona, has conducted research showing that sensitized infants are most likely to develop the classic syndrome we call asthma. |
We can reach some conclusions from the high prevalence of respiratory and related health-care utilization among African-American and Dominican infants from northern Manhattan and the South Bronx during the first three months of life. While these symptoms do not establish a diagnosis of asthma at that early age, most likely they represent the early onset of asthma for some infants. |
We are beginning to deal with the challenge of characterizing disproportionate exposures in our communities that may have--and do have, in some instances--a relationship to health outcomes. It is very important to stress that for a lot of these exposures we may not know how to control them, or bring them to levels that may actually prevent disease. |
Research is going on right now, for example, with regard to exposure to cockroaches. I would like to mention this because it's not about how well or poorly you clean your house. According to Miller, the bottom line is that the cockroach allergen is ubiquitous. It is in practically every home in the urban environment. The challenge for us as researchers, community members and policymakers is to provide answers and ultimately utilize what we learn to impact public health. |
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