Since the 1960s, scientists and public health experts believed that childhood asthma — symptoms of which can be triggered by environmental irritants and allergens — was most common in the inner cities.
Children living in poor urban neighborhoods, they reasoned, were far more likely than suburban and rural children to be exposed to asthma triggers like cockroaches, mold, pollution, and secondhand smoke. Higher rates of premature birth and maternal stress among inner-city families were also thought to contribute to higher rates of pediatric asthma in the urban poor.
But today, factors like pollution, bad housing, and poverty aren’t confined to the inner city. Families in suburban and rural areas are just as likely to be struggling with poverty, living in cockroach-infested, substandard housing, and breathing polluted air. That’s what researchers at Johns Hopkins Children’s Center believe, and it’s why they compared the asthma rates of more than 23,000 American children living in urban, suburban, and rural areas. Contrary to accepted wisdom, the researchers found that inner-city living is not a risk factor for childhood asthma at all. Instead, family poverty and race are bigger indicators of a given child’s asthma risk.
City Living Not a Risk Factor for Pediatric Asthma
While it’s true that children living in the inner cities 50 years ago had high rates of asthma, the Johns Hopkins researchers point out that no one ever compared asthma rates among inner city children with those among children living in suburban and rural areas. That’s why the researchers surveyed the parents and guardians of 23,065 American children, aged 6 to 17, and living in inner city, suburban, and rural or small-town communities. They found that 13 percent of the inner-city kids suffered from asthma, compared with 11 percent of the suburban and rural children. When the researchers controlled for such factors as ethnicity, race, and geographic region, however, they found that the small difference in asthma rates between inner-city and suburban or rural kids vanished.
Kids Living With Family Poverty at Highest Risk for Asthma
While all children with asthma depend on Advair to get through the day, kids in poorer families are the more likely to require hospitalization and emergency treatment for asthma attacks. Regardless of the incomes of others in their neighborhoods, kids living in poor families were the most likely to develop asthma. And the lower the yearly family income, the higher the risk of asthma, the researchers found.
Why? Even in rural and suburban areas, poor families are likely to live in substandard housing and deal with issues like cockroaches, mice, and mold, all of which can trigger asthma attacks. Poor families smoke more cigarettes, too, and exposure to secondhand smoke is another risk factor for asthma. Children in poor families are more likely to be born premature, and mothers experience more stress during pregnancy. The stress of poverty can affect children in the family, too, leading to more asthma attacks.
Genetics Also Influence Asthma Rates
While environmental triggers can cause asthma attacks, there’s also a genetic factor to the disease. Exact genetic causes have been difficult to decipher, but previous research, and the results of this study, verify that children of African-American and Puerto Rican ancestry have the highest risk of developing asthma, with respective asthma rates of 17 percent and 20 percent.
Asthma rates among non-Puerto Rican Hispanics are about nine percent, while asthma rates among Asian children are about eight percent and asthma rates among white children are about 10 percent. Even when factors like family income, neighborhood income, and geographic location were removed, the researchers found that African-American and Puerto Rican children were more likely to develop asthma due to genetic factors.
Geographic Region and Pediatric Asthma Rates
While researchers found no overarching link between urban residence and asthma risk, they did find that children living in the Northeast were the most likely to develop the disease, with 17 percent of Northeastern children living with asthma. Inner city areas in the western U.S. had the lowest childhood asthma rates — just eight percent of children living there have asthma.
Poor, suburban children in the Northeast had the highest rates of asthma, with 21 percent carrying a diagnosis compared to 17 percent of children living in the inner cities of the Northeast. Twenty-six percent of children living in the suburban Midwest have asthma, while just 15 percent of their inner-city Midwestern counterparts live with the disease.
Contrary to long-held scientific consensus, inner-city living may not be a strong risk factor for childhood asthma. Instead, family poverty and genetics are the biggest predictors. The poorer a family is, the more likely the children of that family are to develop asthma symptoms, due to risk factors like poor housing, exposure to irritants, and stress. Genetics are also a big risk factor for pediatric asthma, with children of Puerto Rican descent experiencing the highest rates of asthma. So, if you live in the suburbs, your children may be at an increased risk of asthma — especially if you’re lower-income.