Malveaux F J, Fletcher-Vincent S A
Department of Microbiology, Howard University College of Medicine, Washington, DC 20059, USA.
Environ Health Perspect. 1995 Sep;103 Suppl 6(Suppl 6):59-62. doi: 10.1289/ehp.95103s659.
Asthma morbidity and mortality are disproportionately high in urban centers, and minority children are especially vulnerable. Factors that contribute to this dilemma include inadequate preventive medical care for asthma management, inadequate asthma knowledge and management skills among children and their families, psychosocial factors, and environmental exposure to allergens or irritants. Living in substandard housing often constitutes excess exposure to indoor allergens and pollutants. Allergens associated with dust mites (DM) and cockroaches (CR) are probably important in both onset and worsening of asthma symptoms for children who are chronically exposed to these agents. Young children spend a great deal of time on or near the floor where these allergens are concentrated in dust. Of children (2 to 10 years of age) living in metropolitan Washington, DC, 60% were found to be sensitive to CR and 72% were allergic to DM. Exposure to tobacco smoke contributes to onset of asthma earlier in life and is a risk factor for asthma morbidity. Since disparity of asthma mortality and morbidity among minority children in urban centers is closely linked to socioeconomic status and poverty, measures to reduce exposure to environmental allergens and irritants and to eliminate barriers to access to health care are likely to have a major positive impact. Interventions for children in urban centers must focus on prevention of asthma symptoms and promotion of wellness.
城市中心的哮喘发病率和死亡率高得不成比例，少数族裔儿童尤其脆弱。造成这一困境的因素包括哮喘管理的预防性医疗护理不足、儿童及其家庭的哮喘知识和管理技能不足、社会心理因素以及接触环境中的过敏原或刺激物。居住在不合标准的住房中往往意味着过度接触室内过敏原和污染物。对于长期接触尘螨（DM）和蟑螂（CR）过敏原的儿童来说，与这些过敏原相关的物质可能在哮喘症状的发作和恶化中都起着重要作用。幼儿在这些过敏原集中的灰尘所在的地板上或附近花费大量时间。在华盛顿特区大都市生活的（2至10岁）儿童中，发现60%对蟑螂过敏，72%对尘螨过敏。接触烟草烟雾会导致哮喘在生命早期发作，并且是哮喘发病的一个风险因素。由于城市中心少数族裔儿童哮喘死亡率和发病率的差异与社会经济地位和贫困密切相关，减少接触环境过敏原和刺激物以及消除获得医疗保健障碍的措施可能会产生重大的积极影响。针对城市中心儿童的干预措施必须侧重于预防哮喘症状和促进健康。
