title: Social determinants of childhood asthma symptoms: an ecological study in urban Latin America.
abstract: Asthma is an important public health problem in urban Latin America. This study aimed to analyze the role of socioeconomic and environmental factors as potential determinants of asthma symptoms prevalence in children from Latin American (LA) urban centers. We selected 31 LA urban centers with complete data, and an ecological analysis was performed. According to our theoretical framework, the explanatory variables were classified in three levels: distal, intermediate, and proximate. The association between variables in the three levels and prevalence of asthma symptoms was examined by bivariate and multivariate linear regression analysis weighed by sample size. In a second stage, we fitted several linear regression models introducing sequentially the variables according to the predefined hierarchy. In the final hierarchical model Gini Index, crowding, sanitation, variation in infant mortality rates and homicide rates, explained great part of the variance in asthma prevalence between centers (R(2) = 75.0 %). We found a strong association between socioeconomic and environmental variables and prevalence of asthma symptoms in LA urban children, and according to our hierarchical framework and the results found we suggest that social inequalities (measured by the Gini Index) is a central determinant to explain high prevalence of asthma in LA.
authors.affiliation: Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil, giselfattore@yahoo.com.ar.
authors.forename: Gisel L
authors.initials: GL
authors.lastname: Fattore
authors.forename: Carlos A T
authors.initials: CA
authors.lastname: Santos
authors.forename: Mauricio L
authors.initials: ML
authors.lastname: Barreto
mesh_terms: D001249:Asthma / Q000453:epidemiology*; D002648:Child; D004777:Environment; D005260:Female; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D064890:Social Determinants of Health / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014505:Urban Population
references.citation: Eur Respir J. 2007 Jun;29(6):1154-60
references.pmid: 17331964
references.citation: Am J Public Health. 2004 Apr;94(4):625-32
references.pmid: 15054016
references.citation: Int J Epidemiol. 1997 Feb;26(1):224-7
references.pmid: 9126524
references.citation: Thorax. 1998 Dec;53(12):1066-74
references.pmid: 10195081
references.citation: Health Place. 2006 Jun;12(2):167-79
references.pmid: 16338632
references.citation: J Allergy Clin Immunol. 2006 May;117(5):969-77; quiz 978
references.pmid: 16675321
references.citation: Pediatr Pulmonol. 2003 Apr;35(4):296-301
references.pmid: 12629628
references.citation: Thorax. 2009 Jun;64(6):476-83
references.pmid: 19237391
references.citation: Chest. 2001 Sep;120(3):785-90
references.pmid: 11555510
references.citation: Thorax. 2007 Sep;62(9):758-66
references.pmid: 17504817
references.citation: Respir Res. 2010 Dec 01;11:167
references.pmid: 21122116
references.citation: Am J Public Health. 2003 Nov;93(11):1858-64
references.pmid: 14600053
references.citation: Pediatrics. 2006 Jan;117(1):43-53
references.pmid: 16396859
references.citation: Am J Public Health. 2005 Aug;95(8):1375-81
references.pmid: 15985644
references.citation: Am J Public Health. 2002 May;92(5):758-68
references.pmid: 11988443
references.citation: BMC Public Health. 2007 Aug 13;7:205
references.pmid: 17697314
references.citation: Rev Panam Salud Publica. 2010 Dec;28(6):405-11
references.pmid: 21308166
references.citation: Thorax. 2011 Dec;66(12):1043-50
references.pmid: 21825085
references.citation: J Epidemiol Community Health. 2000 Jun;54(6):411-3
references.pmid: 10818115
references.citation: Curr Opin Allergy Clin Immunol. 2012 Apr;12(2):171-8
references.pmid: 22391754
references.citation: Pediatrics. 2009 Mar;123 Suppl 3:S174-84
references.pmid: 19221161
references.citation: Curr Opin Allergy Clin Immunol. 2012 Apr;12(2):202-10
references.pmid: 22266773
references.citation: Lancet. 2000 Sep 23;356(9235):1093-8
references.pmid: 11009159
references.citation: Cad Saude Publica. 2012 Jan;28(1):86-94
references.pmid: 22267068
references.citation: Clin Immunol. 2011 Apr;139(1):57-64
references.pmid: 21285005
references.citation: Allergol Immunopathol (Madr). 2000 Sep-Oct;28(5):283-6
references.pmid: 11270090
references.citation: Allergy. 2009 Jan;64(1):5-17
references.pmid: 19076533