Skip to main content

Advertisement

SpringerLink
Log in

Trends in Racial and Ethnic Disparities in Childhood Asthma in Miami, Florida: 2005–2013

  • Original Paper
  • Published:
Journal of Immigrant and Minority Health Aims and scope Submit manuscript

Abstract

Nationally, racial and ethnic disparities in childhood asthma plateaued from 2005 to 2013. We assessed trends in childhood asthma in Miami, Florida using Youth Risk Behavior Surveillance System (YRBSS) data and emergency department (ED) utilization and hospitalization rates by zip code population characteristics. Asthma prevalence in Miami did not vary significantly by race/ethnicity in YRBSS respondents in 2005 (16.2–17.2%, all groups), but rose in African–Americans and Hispanics and declined in Whites by 2013 to 27.9, 20.9 and 12.6%, respectively (P = 0.02). Median asthma ED visit rates rose from 106.8 (2006–2008) to 138.2 (2011–2013; P = 0.004) per 10,000 children. High-poverty and majority African–American zip codes were 6.3 and 7.3 times more likely to have asthma ED visit rates > 200 than others (P < 0.001). In high-poverty zip codes, majority African–American population was not associated with significantly higher ED utilization. In low-poverty zip codes, the association became stronger. Greater poverty explains much, but not all of Miami African–Americans’ higher asthma risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bloom B, Jones LI, Freeman G. Summary health statistics for U.S. children: National Health Interview Survey, 2012. National Center for Health Statistics. Vital Health Stat. 2013;10:4, 7.

    Google Scholar 

  2. National Heart, Lung, and Blood Institute (NHLBI). National Institutes of Health. National Asthma Education and Prevention Program Expert Panel Report 3: guidelines for the diagnosis and management of asthma, Aug, 2007. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf. Accessed 7 Dec 2015.

  3. Dean BB, Calimlim BM, Kindermann SL, Khandker RK, Tinkelman D. The impact of uncontrolled asthma on absenteeism and health-related quality of life. J Asthma. 2009;46:861–6.

    Article  Google Scholar 

  4. Oraka E, Iqbal S, Flanders WD, Brinker K, Garbe P. Racial and ethnic disparities in current asthma and emergency department visits: findings from the National Health Interview Survey, 2001–2010. J Asthma. 2013;50:488–96.

    Article  Google Scholar 

  5. Butz AM, Kub J, Bellin MH, Frick KD. Challenges in providing preventive care to Inner-city children. Nurs Clin N Am. 2013;48(2):241–57.

    Article  Google Scholar 

  6. Akinbami LJ, Moorman JE, Simon AE, Schoendorf KC. Trends in racial disparities for asthma outcomes among children 0 to 17 years, 2001–2010. J Allergy Clin Immunol. 2014;134:547–53.e5.

    Article  Google Scholar 

  7. Department of Regulatory and Economic Resources. Planning Research Section. Miami/Dade County Government. Poverty in Miami-Dade. US Census Bureau. American Community Survey 2012. 2015. http://www.miamidade.gov/planning/library/reports/at-a-glance/2012-poverty.pdf. Accessed 1Nov 2015.

  8. Page TF, Beck-Sague CM, Pinzon-Iregui MC, Cuddihy A, Tyler T, Forno E, Dean AG, Siven J, Pottinger S, Gasana J. Asthma in underserved schoolchildren in Miami, Florida: results of a school- and community-based needs assessment. J Asthma. 2013;50:480–7.

    Article  Google Scholar 

  9. Kann L, Kinchen S, Shanklin SL, Flint KH, Kawkins J, Harris WA, Lowry R, Olsen EO, McManus T, Chyen D, Whittle L, Taylor E, Demissie Z, Brener N, Thornton J, Moore J, Zaza S. Division of Adolescent and School Health, National Center for HIV/AIDS, viral hepatitis, STD, and TB prevention, CDC. Youth risk behavior surveillance: United States, 2013. MMWR Surveill Summ. 2014;63(Suppl 4):1–168.

    Google Scholar 

  10. Centers for Disease Control and Prevention. Youth online interactive data tables. 2015. http://nccd.cdc.gov/youthonline/App/Default.aspx. Accessed 10 Dec 2015.

  11. Miami Matters. Community dashboard for pediatric asthma. 2016. http://www.miamidadematters.org/. Accessed 29 March 2016.

  12. USA.com. Local guide to cities, towns, neighborhoods, states, counties, metro areas, zip codes, area codes, and schools in USA. Population in Poverty. Housing: Median Built Year. 2008–2012 US Census. 2016. http://www.usa.com/. Accessed 29 March 2016.

  13. Smiley D. ‘Re-segregation’ trend: 60 years after ruling, dozens of Miami-Dade schools remain isolated. 2016. http://www.miamiherald.com/2014/05/19/4124587/re-segregation-trend-60-years.html. Accessed 29 March 2016.

  14. Gamio L. Miami-Dade County Public Schools, National Center for Education Statistics. Online Tool. 2016. http://www.miamiherald.com/projects/2014/school-demographics. Accessed 29 March 2016.

  15. Dean AG, Sullivan KM, Soe MM. Epi Info and OpenEpi in epidemiology and clinical medicine: health applications of free software. Paramount: CreateSpace; 2010.

    Google Scholar 

  16. Centers for Disease Control and Prevention. Health United States. 2014. http://www.cdc.gov/nchs/data/hus/hus14.pdf#089. Table 89 (page 1 of 3). Discharge rate in nonfederal short-stay hospitals, by sex, age, and selected first-listed diagnosis: United States, selected years 1990 through 2009–2010, with special feature on adults aged 55–64. Hyattsville, MD. 2015. Accessed 29 March 2016.

  17. Gergen PJ, Togias A. Inner City Asthma. Immunol Allergy Clin N Am. 2016; 2015:101–114. http://dx.doi.org/10.1016/j.iac.2014.09.006. Accessed 29 March 2016.

  18. Findley S, Lawler K, Bindra M, Maggio L, Penachio MM, Maylahn C. Elevated asthma and indoor environmental exposures among Puerto Rican children of East Harlem. J Asthma. 2003;40:557–69.

    Article  Google Scholar 

  19. Cureton S. Environmental victims: environmental injustice issues that threaten the health of children living in poverty. Rev Environ Health. 2011;26:141–7.

    Article  Google Scholar 

  20. Powell DL, Children SV. The unwitting target of environmental injustices. Pediatr Clin N Am. 2001;48:1291–305.

    Article  CAS  Google Scholar 

  21. Gasana J, Chamorro A. Environmental lead contamination in Miami inner-city area. J Expo Anal Environ Epidemiol. 2002;12:265–72.

    Article  CAS  Google Scholar 

  22. Gasana J, Dillikar D, Mendy A, Forno E, Ramos Viera E. Motor vehicle air pollution and asthma in children: a meta-analysis. Environ Res. 2012;117:36–45.

    Article  CAS  Google Scholar 

  23. Boehmer TK, Foster SL, Henry JR, Woghiren-Akinnifesi EL, Yip FY, Centers for Disease Control and Prevention (CDC). Residential proximity to major highways: United States, 2010. MMWR Surveill Summ. 2013;62(Suppl 3):46–50.

    Google Scholar 

  24. CLRsearch. Miami pollution indexes. In: 2010 pollution indexes. 2016. http://www.clrsearch.com/Miami-Demographics/FL/Pollution-Levels. Accessed 1 June 2016.

  25. Gasana J, Hlaing WM, Siegel KA, Chamorro A, Niyonsenga T. Blood lead levels in children and environmental lead contamination in Miami inner city, Florida. Int J Environ Res Public Health. 2006;3:228 – 34.

    Article  CAS  Google Scholar 

  26. Phipatanakul W, Eggleston PA, Wright EC, Wood RA. Mouse allergen. I. The prevalence of mouse allergen in inner-city homes. The National Cooperative Inner-City Asthma Study. J Allergy Clin Immunol. 2000;106:1070–4.

    Article  CAS  Google Scholar 

  27. Matsui EC, Eggleston PA, Buckley TJ, Krishnan JA, Breysse PN, Rand CS, Diette GB. Household mouse allergen exposure and asthma morbidity in inner-city preschool children. Ann Allergy Asthma Immunol. 2006;97:514–20.

    Article  Google Scholar 

  28. Brannigan M. A lopsided comeback. How the housing recovery favors the rich: An analysis of 11 years of home sales in South Florida, parsed by ZIP code, shows the boom, bust and recovery left a wider gap between the rich and poor. 2016. http://media.miamiherald.com/static/media/projects/2014/zipcode/stories/overview/. Accessed 29 March 2016.

  29. Beck AF, Huang B, Chundur R, Kahn RS. Code violation density associated with emergency department and hospital use by children with asthma. Health Aff (Millwood). 2014;33:1993–2002.

    Article  Google Scholar 

  30. Parish SL, Rose RA, Yoo J, Swaine JG. State Medicaid policies and the health care access of low-income children with special health care needs living in the American South. N C Med J. 2012;73:15–23.

    PubMed  Google Scholar 

  31. Carroll J. Florida’s MCO Medicaid path may be taken by other states. Manag Care. 2011;20:9–10.

    PubMed  Google Scholar 

  32. Parish SL, Shattuck PT, Rose RA. Financial burden of raising CSHCN: association with state policy choices. Pediatrics. 2009;124(Suppl 4):S435–4.

    Article  Google Scholar 

  33. Millman J. Florida’s Republican governor says he no longer supports expanding Medicaid. Washington Post April 6, 2015. http://www.washingtonpost.com/blogs/wonkblog/wp/2015/04/06/floridas-republican-governor-just-flip-flopped-on-the-medicaid-expansion/. Accessed 29 March 2016.

  34. Reid M, Fiffer M, Gunturi N, Ali A, Irish D, Sandel M. Breathe easy at home: a web-based referral system linking clinical sites with housing code enforcement for patients with asthma. J Environ Health. 2014;76:36–9.

    PubMed  Google Scholar 

  35. Levy JI, Brugge D, Peters JL, Clougherty JE, Saddler SS. A community-based participatory research study of multifaceted in-home environmental interventions for pediatric asthmatics in public housing. Soc Sci Med. 2006;63:2191–203.

    Article  Google Scholar 

  36. Crocker DD, Kinyota S, Dumitru GG, Ligon CB, Herman EJ, Ferdinands JM, Hopkins DP, Lawrence BM, Sipe TA, Task Force on Community Preventive Services. Effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity: a community guide systematic review. Am J Prev Med. 2011;41(2 Suppl 1):S5–32.

    Article  Google Scholar 

  37. Sever ML, Salo PM, Haynes AK, Zeldin DC. Inner-city environments and mitigation of cockroach allergen. Am J Prev Med. 2011;41(2 Suppl 1):S55–6.

    Article  Google Scholar 

  38. Centers for Disease Control and Prevention (CDC). Reducing childhood asthma through community-based service delivery: New York City, 2001–2004. MMWR. 2005;54:11–4.

    Google Scholar 

  39. Murphy JS, Sandel MT. Asthma and social justice: how to get remediation done. Am J Prev Med. 2011;41(2 Suppl 1):S57–8.

    Article  Google Scholar 

  40. Nicholas SW, Jean-Louis B, Ortiz B, Northridge M, Shoemaker K, Vaughan R, Rome M, Canada G, Hutchinson V. Addressing the childhood asthma crisis in Harlem: the Harlem Children’s Zone Asthma Initiative. Am J Public Health. 2005;95:245–9.

    Article  Google Scholar 

  41. Szefler SJ, Gergen PJ, Mitchell H, Morgan W. Achieving asthma control in the inner city: do the National Institutes of Health Asthma Guidelines really work? J Allergy Clin Immunol. 2010;125:521–6.

    Article  Google Scholar 

  42. Beck AF, Huang B, Simmons JM, Moncrief T, Sauers HS, Chen C, Ryan PH, Newman NC, Kahn RS. Role of financial and social hardships in asthma racial disparities. Pediatrics. 2014;133:431–9.

    Article  Google Scholar 

  43. Lewis P, Fagnano M, Koehler A, Halterman JS. Racial disparities at the point of care for urban children with persistent asthma. J Commun Health. 2014;39:706–11. https://doi.org/10.1007/s10900-013-9815-5.

    Article  Google Scholar 

  44. Mitchell SJ, Bilderback AL, Okelo SO. Racial disparities in asthma morbidity among pediatric patients seeking asthma specialist care. Acad Pediatr. 2016;16:64–7.

    Article  Google Scholar 

  45. Flores G, Snowden-Bridon C, Torres S, Perez R, Walter T, Brotanek J, Lin H, Tomany-Korman S. Urban minority children with asthma: substantial morbidity, compromised quality and access to specialists, and the importance of poverty and specialty care. J Asthma. 2009;46:392–8.

    Article  Google Scholar 

  46. Goyal MK, Kuppermann N, Cleary SD, Teach SJ, Chamberlain JM. Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr. 2015;169:996–1002.

    Article  Google Scholar 

  47. Willi SM, Miller KM, DiMeglio LA, Klingensmith GJ, Simmons JH, Tamborlane WV, Nadeau KJ, Kittelsrud JM, Huckfeldt P, Beck RW, Lipman TH, T1D Exchange Clinic Network. Racial-ethnic disparities in management and outcomes among children with type 1 diabetes. Pediatrics. 2015;135:424–34.

    Article  Google Scholar 

  48. Kadan-Lottick NS, Ness KK, Bhatia S, Gurney JG. Survival variability by race and ethnicity in childhood acute lymphoblastic leukemia. JAMA. 2003;290:2008–14.

    Article  CAS  Google Scholar 

  49. Beck AF, Huang B, Auger KA, Ryan PH, Chen C, Kahn RS. Explaining racial disparities in child asthma readmission using a causal inference approach. JAMA Pediatr. 2016;170:695–703.

    Article  Google Scholar 

  50. Evans R 3rd, Gergen PJ, Mitchell H, et al. A randomized clinical trial to reduce asthma morbidity among inner-city children: results of the National Cooperative Inner-City Asthma Study. J Pediatr. 1999;135:332–8.

    Article  Google Scholar 

  51. Bruzzese JM, Sheares BJ, Vincent EJ, et al. Effects of a school-based intervention for urban adolescents with asthma. A controlled trial. Am J Respir Crit Care Med. 2011;183:998–1006.

    Article  Google Scholar 

  52. Halterman JS, Szilagyi PG, Fisher SG, et al. Randomized controlled trial to improve care for urban children with asthma: results of the school-based asthma therapy trial. Arch Pediatr Adolesc Med. 2011;165:262–8.

    Article  Google Scholar 

  53. Flores G, Bridon C, Torres S, et al. Improving asthma outcomes in minority children: a randomized, controlled trial of parent mentors. Pediatrics. 2009;124:1522–32.

    Article  Google Scholar 

  54. Lieu TA, Finkelstein JA, Lozano P, Capra AM, Chi FW, Jensvold N, Quesenberry CP, Farber HJ. Cultural competence policies and other predictors of asthma care quality for Medicaid-insured children. Pediatrics. 2004;114:e102–10.

    Article  Google Scholar 

  55. American Academy of Pediatrics (AAP) Council on Community Pediatrics. Poverty child health in the United States. Pediatrics. 2016;137:e20160339.

    Article  Google Scholar 

Download references

Funding

No funding was received for this study.

Author information

Author notes

  1. Janvier Gasana

    Present address: Department of EOH, Kuwait University, Kuwait City, Kuwait

  2. Benjamin Ortiz

    Present address: Immunology and Inflammation Medical Unit, Sanofi, East Hanover, NJ, USA

Authors and Affiliations

  1. Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA

    Consuelo M. Beck-Sague, Alejandro Arrieta, M. Claudia Pinzon-Iregui & Janvier Gasana

  2. Columbia University Medical Center, New York, NY, USA

    Benjamin Ortiz

  3. Harlem Hospital Center, New York, NY, USA

    Benjamin Ortiz

  4. EpiInformatics, Inc., Miami, FL, USA

    Andrew G. Dean

  5. South Florida Asthma Consortium, Ft. Lauderdale, FL, USA

    Andrew Cuddihy & Janvier Gasana

  6. Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8 Street, AHC 5-410, Miami, FL, 33199, USA

    Consuelo M. Beck-Sague

Authors
  1. Consuelo M. Beck-Sague
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alejandro Arrieta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Claudia Pinzon-Iregui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Benjamin Ortiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrew G. Dean
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrew Cuddihy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Janvier Gasana
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Consuelo M. Beck-Sague.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest with this research.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors. All studies consisted of secondary data analysis.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Beck-Sague, C.M., Arrieta, A., Pinzon-Iregui, M.C. et al. Trends in Racial and Ethnic Disparities in Childhood Asthma in Miami, Florida: 2005–2013. J Immigrant Minority Health 20, 1429–1437 (2018). https://doi.org/10.1007/s10903-017-0686-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10903-017-0686-1

Keywords

Search

Navigation