Current Asthma Among Children
In 2009–2010 asthma prevalence was higher for children living in poverty than for those with higher relative family income, but this pattern did not hold for Hispanic children.
Asthma is a chronic disease characterized by attacks of breathing difficulty; its prevalence is at historically high levels (1,2). Childhood asthma causes significant morbidity and is a major reason for emergency department visits and hospitalizations (1). Some risk factors include genetic predisposition and exposure to environmental allergens, including outdoor air pollution (2–4). Once asthma develops, many triggers for attacks exist, including indoor allergens such as dust mites, cockroaches, pets, and molds. Secondhand tobacco smoke is a major asthma trigger, and poor children are more likely to be exposed to second-hand smoke (2,5,6). Socioeconomic status and having health insurance are related to control of asthma symptoms (7,8). Families with less comprehensive prescription drug coverage (and higher out-of-pocket costs) are less likely to purchase asthma maintenance drugs (7).
In 2009–2010, current asthma prevalence was lowest for children living at 200% or more of poverty, higher for children in families at 100%–199% poverty, and highest for children living in poverty. Asthma prevalence did not vary by relative family income for Hispanic children. In contrast, non-Hispanic white and non-Hispanic black children living in poverty were more likely to have asthma than their counterparts at 200% or more of the poverty level. Asthma prevalence was higher for non-Hispanic black children and children of Puerto Rican origin than for those in other race and ethnicity groups (data table for Figure 23).
Figure 23Current asthma among children under 18 years of age, by race and Hispanic origin and percent of poverty level: United States, 2009–2010
- Akinbami LJ, Moorman JE, Garbe PL, Sondik EJ. Status of childhood asthma in the United States, 1980–2007. Pediatrics. 2009;123(suppl 3):S131–45. [PubMed: 19221156]
- National Institute of Environmental Health Sciences. Asthma and its environmental triggers. Available from: http://www
.niehs.nih .gov/health/materials /respiratory_disease _and_the_environment.pdf.
- Akinbami L, Parker J, Woodruff T. Association between outdoor air pollution and childhood asthma symptoms in metropolitan areas, United States. Epidemiology. 2006;17(6):S275. [abstract]
- Ahluwalia SK, Matsui EC. The indoor environment and its effects on childhood asthma. Curr Opin Allergy Clin Immunol. 2011;11(2):137–43. [PubMed: 21301330]
- Halterman JS, Montes G, Shone LP, Szilagyi PG. The impact of health insurance gaps on access to care among children with asthma in the United States. Ambul Pediatr. 2008;8(1):43–9. [PubMed: 18191781]
Attention Deficit Hyperactivity Disorder Among Children
In 2009–2010, children living below 200% of the poverty level were more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD or ADD) than children with higher relative family income, but this pattern differed across racial and ethnic groups.
ADHD (or ADD) is one of the most common childhood neurobehavioral disorders (1,2). Reported ADHD prevalence increased from 7% in 1997–1999 to 9% in 2008–2010 (Table 46). The economic effect of ADHD on families, schools, and the health care system is substantial (3). Children with ADHD are more likely than children without ADHD to use prescription medication (3,4). The percentage of children who had recently used prescription stimulants for ADHD increased from less than 1% to nearly 4% from 1988–1994 to 2005–2008 (Table 100). Poor children are less likely to receive medication on a regular basis to treat their ADHD than children living in families with higher incomes (5).
In 2009–2010, 1 of 10 children 5–17 years of age had been diagnosed with ADHD according to the parent or knowledgeable adult in the family. Children with family income below 200% of poverty were diagnosed with ADHD more often than children with family income at 200% or more of the poverty level. Non-Hispanic white children with family income below 200% of the poverty level were diagnosed with ADHD more often than those with higher relative family income. For non-Hispanic black children, the percentage diagnosed with ADHD was higher among poor children than among those in other relative family income groups. For Hispanic children, there was no difference in ADHD prevalence by relative family income. Prevalence of ADHD was more than twice as high among non-Hispanic white and non-Hispanic black children than among Hispanic children.
Figure 24Attention deficit hyperactivity disorder among children 5–17 years of age, by race and Hispanic origin and percent of poverty level: United States, 2009–2010
- Fulton BD, Scheffler RM, Hinshaw SP, Levine P, Stone S, Brown TT, Modrek S. National variation of ADHD diagnostic prevalence and medication use: Health care providers and education policies. Psychiatr Serv. 2009;60(8):1075–83. [PubMed: 19648195]
- Akinbami LJ, Liu X, Pastor PN, Reuben CA. NCHS data brief, no 70. Hyattsville, MD: NCHS; 2011. Attention deficit hyperactivity disorder among children aged 5–17 years in the United States, 1998–2009. Available from: http://www
.cdc.gov/nchs /data/databriefs/db70.pdf. [PubMed: 22142479]
- Pastor PN, Reuben CA. Diagnosed attention deficit hyperactivity disorder and learning disability: United States, 2004–2006. NCHS. Vital health stat. 2008;10(237) Available from: http://www
.cdc.gov/nchs /data/series/sr_10/Sr10_237.pdf. [PubMed: 18998276]
- Froehlich TE, Lanphear BP, Epstein JN, Barbaresi WJ, Katusic SK, Kahn RS. Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Arch Pediatr Adolesc Med. 2007;161(9):857–64. Available from: http://archpedi
.ama-assn .org/cgi/reprint/161/9/857. [PubMed: 17768285]
National Center for Health Statistics (US), Hyattsville (MD)
National Center for Health Statistics (US). Health, United States, 2011: With Special Feature on Socioeconomic Status and Health. Hyattsville (MD): National Center for Health Statistics (US); 2012 May. Morbidity.