Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Community Health. 2020 Oct;45(5):1017-1026. doi: 10.1007/s10900-020-00822-y.
Traditional measures of socioeconomic status (SES) are associated with asthma morbidity, but their specific contributions are unclear. Increased exposure to indoor allergens among low SES children is an important consideration. Material hardship, a concept describing poor access to basic goods and services, may explain the relationship between low SES and indoor allergen exposure, and thereby, the increased risk of asthma morbidity. We sought to (i) describe the specific hardships experienced by low-Income, urban, minority children with asthma and indoor allergen sensitization and (ii) determine if material hardship is associated with indoor allergen exposure in this population. We conducted a cross-sectional analysis of children undergoing the baseline assessment for a clinical trial of home environmental modification. Participants were scored in five domains of material hardship. Domain scores were assigned based on caregiver responses to a questionnaire and were summed to generate a total material hardship score. Linear regression was used to examine the relationship between material hardship scores and bedroom floor concentrations of five common indoor allergens. Participants experienced high levels of material hardship in each of the five domains, with 33% not having access to a car, 35% not being able to pay utility bills, and 28% not being able to pay rent in the past year. Each one-point increase in material hardship was associated with an increase in cockroach allergen of 16.2% (95% CI 9.4%, 24.6%) and an increase in mouse allergen of 9.4% (95% CI 1.0%, 18.5%). After adjusting for traditional measures of SES, including household income, health insurance type, caregiver education, and caregiver employment status, the association between material hardship and cockroach allergen, but not mouse allergen, remained. These data suggest that a significant proportion of families of low-income, minority children with asthma may experience material hardship, and that they may be at greater risk of cockroach allergen exposure than their peers with similar income, but without material hardship.
传统的社会经济地位（SES）衡量标准与哮喘发病率有关，但它们的具体贡献尚不清楚。低 SES 儿童接触室内过敏原的机会增加是一个重要的考虑因素。物质困难是一个描述获取基本商品和服务的机会有限的概念，它可能解释了 SES 较低与室内过敏原暴露之间的关系，从而增加了哮喘发病率的风险。我们试图：（i）描述哮喘和室内过敏原致敏的低收入、城市、少数族裔儿童所经历的具体困难；（ii）确定在该人群中物质困难是否与室内过敏原暴露有关。我们对正在进行家庭环境改良临床试验基线评估的儿童进行了横断面分析。参与者在物质困难的五个领域中进行评分。根据护理人员对问卷的回答，为每个领域分配分数，并将分数相加得出总的物质困难分数。线性回归用于检验物质困难分数与五种常见室内过敏原的卧室地板浓度之间的关系。参与者在五个领域中都经历了高水平的物质困难，其中 33%的人没有汽车，35%的人无法支付水电费，28%的人在过去一年无法支付租金。物质困难每增加一个点，蟑螂过敏原就会增加 16.2%（95%置信区间 9.4%，24.6%），老鼠过敏原增加 9.4%（95%置信区间 1.0%，18.5%）。在调整了传统的 SES 衡量标准（包括家庭收入、医疗保险类型、护理人员教育程度和护理人员就业状况）后，物质困难与蟑螂过敏原之间的关联仍然存在，但与老鼠过敏原之间的关联则不存在。这些数据表明，相当一部分低收入、少数族裔哮喘儿童的家庭可能会经历物质困难，而且他们接触蟑螂过敏原的风险可能比收入相似但没有物质困难的同龄人更高。
