Increased Cases of Asthma in Low Socioeconomic Children Explained

Sydney M. Neff

The Ohio State University

Increased cases of asthma in low socioeconomic children explained

Asthma is quickly becoming an epidemic in The United States of America. According to National Health Interview Survey, 7.3 percent of the U.S. population was diagnosed or had asthma in 2001, compared to 8.4 percent (25.7 million people) in 2010 (Akinbami et al., 2016). Asthma is a condition in which a person’s ability to breathe becomes challenging because airways of the lungs are chronically inflamed. As asthma rises, health disparities within different populations can be noted. The majority of people with asthma were children ages one to eight because they are in a critical point of lung development particularly those from chronically low-socioeconomic status families (Kozyrskj et al., 2010). Low socioeconomic status is often measured as a combination of minimal education (less than high school), low income (less than $47,000 a year for a family of four) and perceived inferior occupation (American Psychological Association, 2009). Anita Kozyrskj and colleagues (2010) conducted a longitudinal study with 2,865 children and found that among low -income families, 22 percent of children developed asthma by age 6 compared to 18 percent in those consisted not low-income families. Children of low-socioeconomic status also experience greater symptoms of asthma, including more frequent hospital stays and emergency room visits (Schreier & Chen, 2013). Children of a low-socioeconomic status have a higher and more severe prevalence of asthma due to increased exposure to pollution, inability to pay for treatment, and general distrust of the healthcare system.

High amounts of pollution in low-socioeconomic status neighborhoods has shown to exacerbate asthma symptoms in children. Portnova and his colleagues (2012) analyzed the medical records of 3,922 children in northern Israel and compared each individual to the estimated amount of pollution they were exposed to using Geographic Information Systems and

Bayesian Model Averaging Tools. In this study it was also found that rates of childhood asthma differed based on the community where the child resided. In the wealthy town of Qiryat Tivon, 8.7% of children have asthma, compared to 21.4% in the densely populated low-income city of Qiryat Yam (Portnova et al, 2012). This geographical disparity is observed because families with low income are forced to live in houses that they can afford which is often in areas of overcrowded neighborhoods close to manufacturing plants with a lot of traffic. O’Connor et al. (2008) conducted a study in which he repeatedly assessed the lung function of 861 children, ages 5-12 while comparing it to the measurements from the Aerometric Information Retrieval System on the amount of daily pollution in the area. After 2 years O’Connor et al. (2008) determined that being exposed to pollution below the National Ambient Air Quality Standards leads to respiratory problems. The National Ambient Air Quality Standards are standards set by the Environmental Protection Agency (EPA) under The Clean Air Act on six pollutants considered most dangerous to a person’s health (critical pollutants): carbon monoxide, lead, nitrogen dioxide, ozone, particulate matter, and sulfur dioxide (EPA, 2016). Manufacturing plants emit at least 3 of the critical pollutants (nitrogen dioxide, ozone, and fine particulate matter) into the air making it very unsafe for developing lungs (Grineski, et al., 2007). Manufacturing requires raw materials, which are often delivered diesel trucks, leading to more air pollution in the area. Furthermore, heavy traffic from cars is the one of the main contributors to outdoor pollutants. A study based in California attributed 6–9% of pediatric asthma cases to automobile and truck traffic (Schreier & Chen, 2013). Children of low socioeconomic status are also exposed to more second hand smoke form tobacco, another major air pollutant. According to Martinez, Cline, and Burrows (1992) longitudinal study, children of heavy-smoking mothers with less than a high school education were more likely to develop asthma and have worse lung functioning in the

future. There is clearly a direct relationship between the amount of air pollution in the form of manufacturing plants, automobile, and cigarette emissions and the number of cases of asthma in children. People of low-socioeconomic class often live in areas of high pollution, causing a higher prevalence of asthma.

Currently there is no cure for asthma, but its symptoms can be managed. The severity of the case of asthma determines the level of intervention needed. Mild cases of asthma only need regular checkups with a heath care provider while the more severe cases may need expensive equipment and medication. These costs quickly add up. In 2006, eight billion U.S. dollars were spent on children with asthma, which is about $621 dollars per child annually (Soni, 2006). Families of low-socioeconomic status are not often given the benefit of health-insurance through their jobs so they have to seek private health-insurance and they cannot afford health-insurance to help them. Medicare helps low-income families pay medical bills but is often not enough and the family is forced to make a decision between essential life functions and receiving medical treatment. When treatment is not maintained it can trigger an asthma attack, which can result in an emergency room visit and possibly a hospitalization. A visit to an emergency room is significantly more expensive than an outpatient visit to a healthcare provider. For example, data compared in Texas determined that a check-up for a child in the early stages of asthma was $100 per visit while a 3 day visit to a hospital to treat severe asthma symptoms was $7,300 (Children’s Defense Fund, 2010). It is essential for the health of the child and the finical stability of the family that the child with asthma receives regular care based on that child’s personal needs. Often these needs cannot be met with people of low-socioeconomic status so prevalence of asthma is higher and more sever.

People of low-socioeconomic status also avoid seeking care for a chronic condition like asthma because of unethical research done on people of low-socioeconomic status. As defined by The American Psychological Association, people of low-socioeconomic economic class have minimal education (2009) so they have trouble understanding health information, making them dependent on the health professional’s judgment. Throughout history, health care professionals have taken advantage of people of low-socioeconomic status which resulted in a general mistrust of health care professional. This mistrust has been passed through generations. One example was the case of Henrietta Lacks in 1951. She was a poor tobacco farmer with six years of education diagnosed with cervical cancer and was then treated at John Hopkins University. During her treatment the doctors took a sample of her cancerous cells without Lack’s consent. Lacks would then die without the knowledge or reward of her contribution to science. The scientists discovered that her cells, later labeled as HeLa, could divide quickly and exponentially, therefore the cells were ideal for research. The HeLa cells were shipped all over the world and many organizations got rich selling and researching the HeLa cells. In fact, Henrietta Lacks cancer cells are considered one of the most important medical tools of the twentieth century. The HeLa cells were vital in discovering the polio vaccine, cloning, gene mapping, and in vitro fertilization. Lacks and her family were never recognized or reimburses for her contribution to science. The Lacks family are in low-socioeconomic status, and are uninsured because of their standing, while many organizations rich got rich off of Lack’s cancer cells (Skloot, 2010). The healthcare providers used Lacks and her family’s ignorance as a way to further their own research and wealth. This injustice causes the people of the low-socioeconomic status to avoid care because of the fear that they will be taken advantage of by health professionals. This is further exemplified in the infamous Tuskegee Syphilis Experiment. The study began at the Tuskegee Institute in

1932 with the purpose to study the disease of syphilis and to find the best way to treat it. The participation rates were high for the study consisting of six hundred men. Most of them being of low-socioeconomic status because the participants received free medical check-ups, meals, and burial insurance as a benefit of participating in this study. All the men gave consent to the study but were not fully informed about the purpose of the study (Centers for Disease Control and Prevention, 2015). Researchers withheld that four hundred participants agreed to not receive treatment for syphilis so researcher could observe the pathophysiology of the disease; even when penicillin was found to treat syphilis it was not given to the participants (Kennedy et al., 2007). Participants reported they felt more like guinea pig rather than human beings (Kennedy et al., 2007). People of low-socioeconomic status lack the education required to understand all health information so they blindly follow the instructions of healthcare providers, leaving them exposed and vulnerable for wrong doing. Instead of leaving themselves vulnerable in this way to an attack by healthcare professional they do not visit a health care provider until symptoms are advanced and outcomes are poor. Parents pass this fear of being a lab rat to their children and created a cycle of not receiving care, so children of low socioeconomic status have a more severe symptoms of asthma.

Mistrust of healthcare professionals, lack of financial resources to pay medical bills, and an increase of pollution in the environment leaves children of low-socioeconomic status at an increased risk for developing asthma. Symptoms often become worse based on the amount of pollution a child is exposed to during the crucial part of lung development. Children of low-socioeconomic status live in areas of high pollution and have an increased exposure to second hand smoke. People of low-socioeconomic status often avoid seeking medical attention until symptoms are life threating because they are not able to afford it and there is a general mistrust

of healthcare professionals. In the past, studies have taken advantage of people in the low-socioeconomic class. Healthcare professionals and researchers exploited people of low-socioeconomic status’s lack of education conducted unethical research on them causing a mistrust of the healthcare profession. Many parents are teaching their children not participate in keeping themselves healthy but only fix their problems when they are life threating which leads to worst outcomes and higher costs. Increased exposure to pollution, inability to pay for treatment, and general distrust of the healthcare system causes children of a low-socioeconomic status have a higher and more severe prevalence of asthma.

References

Akinbami, L. J., Simon, A. E., & Schoendorf, K. C. (2016). Trends in allergy prevalence among children aged 0–17 years by asthma status, United States, 2001–2013. Journal of Asthma, 1-7.

Centers for Disease Control and Prevention. (2015, December). U.S. Public Health Service Syphilis Study at Tuskegee. Retrieved from http://www.cdc.gov/tuskegee/timeline.htm

Children’s Defense Fund. (2010, March). Children’s Defense Fund Asthma Health Fact Sheet. Retrieved March 4, 2016, from http://www.childrensdefense.org/library/data/asthma-factsheet.pdf

EPA. (2016, March 4). National Ambient Air Quality Standards (NAAQS). Retrieved from http://www3.epa.gov/ttn/naaqs/criteria.html

Grineski S, Bolin B, Boone C. Criteria air pollution and marginalized populations: Environmental inequity in metropolitan Phoenix, Arizona. Social Science Quarterly. 2007;88(2):535–554. doi: 10.1111/j.1540-6237.2007.00470

Kennedy, B., Mathis, C., & Woods, A. (2007). African Americans and their distrust of the health care system: healthcare for diverse populations. Journal Of Cultural Diversity, 14(2), 56-60 5p.

Kozyrskyj, A. L., Kendall, G. E., Jacoby, P., Sly, P. D., & Zubrick, S. R. (2010). Association Between Socioeconomic Status and the Development of Asthma: Analyses of Income Trajectories. Am J Public Health American Journal of Public Health, 100(3), 540-546.

Martinez FD, Cline M, Burrows B. Increased incidence of asthma in children of smoking mothers.Pediatrics. 1992;89(1):21–26

O’Connor, G. T., Neas, L., Vaughn, B., Kattan, M., Mitchell, H., Crain, E. F., . . . Lippmann, M. (2008). Acute respiratory health effects of air pollution on children with asthma in U.S. inner cities. Journal of Allergy and Clinical Immunology, 121, 1133–1139. doi:10.1016/j.jaci.2008.02.020

Portnov, B. A., Reiser, B., Karkabi, K., Cohen-Kastel, O., & Dubnov, J. (2012). High prevalence of childhood asthma in Northern Israel is linked to air pollution by particulate matter: Evidence from GIS analysis and Bayesian Model Averaging.International Journal of Environmental Health Research, 22(3), 249-269.

Schreier, H. M., & Chen, E. (2013). Socioeconomic status and the health of youth: A multilevel, multidomain approach to conceptualizing pathways. Psychological Bulletin, 139(3), 606-654.

Skloot, R. (2010). The immortal life of Henrietta Lacks. New York: Crown.

Soni, A. The Five Most Costly Children’s Conditions, 2006: Estimates for the U.S. Civilian Noninstitutionalized Children, Aged 0-17. Medical Expenditure Panel Survey: Statistical Brief #242. April 2009.