PREVALENCE, MORBIDITY, AND MORTALITY OF ASTHMA IN THE INNER-CITY

Evidence is mounting that minority urban children are at greater risk both for having asthma and for having more severe disease than their white counterparts. Among children in the youngest age group (0-4 years), hospital discharge rates are nearly twice as high for blacks as for whites. Hospitalization rates for hispanics are less well documented, but in at least one targe urban hospital, the rates for blacks and hispanics are about equal. Asthma mortality is also significantly higher for black children than for white. However, elevated prevalence, morbidity, and mortality rates among inner-city populations may be influenced more by poverty than by race. Low-income urban families are exposed to multiple risk factors that are absent or reduced in more affluent environments. Pollution, substandard housing, overcrowding, vermin, and inadequate access to health care are all more common facts of life among those of low income and little education. Unfortunately, exposure to cigarette smoke-a risk factor that is declining among the general population-remains a serious problem for urban dwellers. Many inner-city residents cope with crime, gang violence, and drug dealing on a daily basis. Living under these circumstances places the urban population at increased risk for substance abuse and a variety of psychologic problems that can lead to dysfunctional family situations, which may in turn impact upon the care of an asthmatic child. With so many potent forces likely contributors to the inner-city asthma problem, it is difficult to determine what contribution (if any) race or ethnic background may play. It may be that, in this population, environmental and socioeconomic factors play a more important (and heredity a less important) part than in other environments.