Psychosocial Associations with Life-Threatening Asthma in Inner City Children
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Mary E. Bollinger, DO FAAAAI, Arlene Butz, ScD,CRNP, Cassie Lewis-Land, MS, Tricia Morphew, MSc
Rationale: Inner city children have high asthma related morbidity and mortality.  Previous studies suggest that psychosocial issues may increase the risk of near-fatal and fatal asthma, but detailed analyses of specific factors in high risk inner city children are scarce.

Methods: Baseline survey data including measures of caregiver depression (CES-D), quality of life, social support and neighborhood stress were collected from caregivers of inner city children with uncontrolled asthma.  All child subjects (N=150) were enrolled in a study evaluating the impact of a multifaceted preventive asthma care intervention.  Comparison of children with and without a prior intensive care (ICU) admission for asthma was conducted using chi-square and logistic regression.  

Results: Subjects were primarily African American (95.3%) and young (mean age 6.4yrs; 64% male); 31% of whom had a prior ICU admission. Caregivers were primarily mothers (92.7%), single (85.2%), employed (53.3%) and very poor (34.6% income <$10,000). Most caregivers reported asthma related daily stress (64.7%), 29.3% had CES-D scores >16, consistent with depression. Most reported some neighborhood related stress with low social embeddedness most commonly reported.   There was a trend for children from very poor households (<$10,000/yr. vs. >$10,000/yr) to have had a prior ICU admission (OR 1.96 (0.92, 4.17) p=0.081).  For caregivers reporting extremely high neighborhood stress, each unit increase in depression (CES-D score) increased the odds of prior ICU admission by 20%, p=0.031.  

Conclusions: Identifying and addressing caregiver depression and stress may help to decrease the high morbidity and  mortality seen in inner city children with poorly controlled asthma.