Population disparities in asthma.
The prevalence of asthma in the United States is higher than in many other countries in the world. Asthma, the most common chronic disease of childhood in the United States, disproportionately burdens many socioeconomically disadvantaged urban communities. In this review we discuss hypotheses for between-country disparities in asthma prevalence, including differences in "hygiene" (e.g., family size, use of day care, early-life respiratory infection exposures, endotoxin and other farm-related exposures, microbial colonization of the infant bowel, exposure to parasites, and exposure to large domestic animal sources of allergen), diet, traffic pollution, and cigarette smoking. We present data on socioeconomic and ethnic disparities in asthma prevalence and morbidity in the United States and discuss environmental factors contributing to asthma disparities (e.g., housing conditions, indoor environmental exposures including allergens, traffic air pollution, disparities in treatment and access to care, and cigarette smoking). We discuss environmental influences on somatic growth (low birth weight, prematurity, and obesity) and their relevance to asthma disparities. The relevance of the hygiene hypothesis to the U.S. urban situation is reviewed. Finally, we discuss community-level factors contributing to asthma disparities.
Gold
Diane R
DR
Harvard Medical School, Channing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts 02467, USA. diane.gold@channing.harvard.edu
Wright
Rosalind
R
D016902:Air Pollution, Indoor / Q000009:adverse effects; D001249:Asthma / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D001722:Birth Order; D002648:Child; D002656:Child Day Care Centers / Q000706:statistics & numerical data; D002908:Chronic Disease; D017281:Cost of Illness; D004781:Environmental Exposure / Q000009:adverse effects; D016021:Epidemiologic Studies; D005006:Ethnicity; D005191:Family Characteristics; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D007223:Infant; D007225:Infant Food; D009017:Morbidity; D011159:Population Surveillance; D015995:Prevalence; D011634:Public Health; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014504:Urban Health / Q000706:statistics & numerical data