Residential hazards, high asthma prevalence and multimorbidity among children in Saginaw, Michigan.
OBJECTIVE
Comorbidities complicate our understanding of childhood asthma and its risk factors. This study examined the relationships between asthma, self-reported burden of disease symptoms and residential hazards in a representative sample of households in Saginaw, Michigan.


METHODS
A population-based cross-sectional survey.


METHODS
The study involved 643 households randomly selected from the City of Saginaw (Michigan) with children 12 years of age or younger or pregnant woman. The survey was completed using random digit dialing, Computer-Assisted Telephone Interviewing (CATI) method. The audit instrument for residential hazards developed for the study was used to gather information on 71 household hazards organized in eight scales (dimensions): structural scale, moisture/mold scale, electrical scale, ventilation and combustion appliances scale, pest scale, pets scale, fire scale, and lifestyle-associated factors scale. The data were used to calculate an aggregate score of the household hazard index (HHI) for each housing unit. We also collected information on 43 symptoms of diseases likely to be associated with exposure to residential hazards as well as the demographic characteristics for each household.


RESULTS
Asthma prevalence rate among the 1206 children was 18.9% with 27.7% of households reporting at least one asthmatic child. The prevalence of health hazards in households of Saginaw was pervasively high with the rate for each of 29 hazards being over 30%. The HHI was found to be a good predictor of health outcomes in homes; the following linear regression equation describes the relationship between childhood asthma and the scores for individual scales of HHI: Number of Asthmatic Children=0.009(Structural)+0.004(Mold) +0 .019(Pests)-0.023(Pets)-0.029(Fire); (r(2)=0.054; p-value<0.001). Children who were living in housing units classified as high risk (top 25% of the HHI score) were found to be disproportionately afflicted with asthma, allergic reaction and burden of symptoms compared to children who lived in low-risk homes. Average number of symptoms in the households was 14±10 and the top 25% of the households had over 26 symptoms. Asthma was associated (comorbid) with each of the 40 symptoms (out of the 43) in the inventory scale, and the HHI was found to be a good predictor of the symptom burden (total count of symptoms) in participating households.


CONCLUSIONS
Recognition of the large extent of comorbidity in asthmatic children has implications for the way in which this disease should be treated or managed. In addition, the study of comorbidity between asthma and related risk factors may be important in understanding complex exposure-disease relationships which could lead to more effective interventions.
Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA. stoten@umich.edu
Jerome
J
Nriagu
Joseph
J
Martin
Pamela
P
Smith
Deborah
D
Socier
D000328:Adult; D001249:Asthma / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D015386:Hazardous Substances / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
D015386:Hazardous Substances