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Childhood Asthma Disparities By Race/Ethnicity Larger Early On, Taper With Age
Prevalence rates for early childhood asthma in the United States show marked racial/ethnic and socio-economic disparities that taper with age, according study findings published in the Annals of the American Thoracic Society.
Investigators assessed how disparities related to race/ethnicity and socioeconomic status (SES) are associated with the age trajectory of asthma burden in US children. Outcomes of interest were age at asthma diagnosis and cumulative asthma prevalence and asthma hospitalization rates.
The investigators conducted a cross-sectional study analyzing 3 datasets with US children up to 17 years of age: the 2018-2019 National Inpatient Sample (NIS) (n=23,713 children with asthma); the 2015-2017 Child Asthma Call-Back Survey (ACBS) (n=4289); and the 2016-2021 National Children's Health Survey (NCHS) (n=223,551). The NIS provided asthma hospitalization rates by age, race, and ethnicity. The ACBS provided data by race, ethnicity, and SES on mean age at asthma diagnosis, adjusted and unadjusted for confounders. The NCHS showed cumulative asthma prevalence by age, race, and ethnicity.
With respect to cumulative asthma prevalence, the researchers found that among White children, prevalence gradually increases through childhood from an early age, with rates of 1.0% before 1 year of age, 6.6% at 5 years of age, and 16.1% at 17 years of age. Black children showed greater asthma prevalence in early childhood, with rates of 2.8% before 1 year of age and 17.6% at 5 years of age, with rates plateauing at 22.8% after 9 years of age. The researchers further noted that Black-White relative disparities in asthma prevalence declined during adolescence (relative risk [RR], 2.6; 95% CI, 1.9-3.8). In Hispanic children, asthma rates went from 0.8% before 1 year of age, to 9.9% at 5 years of age, to 18.5% at 11 years of age, with rates becoming similar to those of White children at adolescence.
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Disparities in asthma prevalence emerge in early childhood and then narrow, suggesting that reducing early-life adverse environmental exposures may be key to asthma prevention.
Asthma prevalence according to SES showed a similar trajectory, with children of lower SES showing higher early-age asthma prevalence rates, and differences in prevalence by SES narrowing as children grew older.
Another notable difference: White and high-income children are diagnosed at a later age than Black, Hispanic, and low-income children. The mean age at diagnosis was 5.0 years among White children; 4.7 years among children from high-income (ie, $50,000+) households; 3.9 years; among Black children; 4.1 years among Hispanic children; and 4.0 to 4.2 years among children from low-income households. Those from the lowest income households were diagnosed at 4.9 years.
Among all children, asthma hospitalization rates rise in the earliest years, although more rapidly among Black children, with the peak absolute Black/White gap reached at 4 years of age. Throughout childhood, the relative Black/White gap remains wide and peaks at 10 years of age. From a per-child perspective among those with asthma, relative disparities rise through 15 years of age in Black/White hospitalizations.
Study limitations include the cross-sectional design, as well as recall and diagnostic bias. Additionally, no distinction was made between differing Hispanic ethnicities; notably, previous research shows Puerto Rican children have a higher asthma prevalence than both Black and White children and that Mexican-American children have a lower asthma prevalence.
"Disparities in asthma prevalence emerge in early childhood and then narrow, suggesting that reducing early-life adverse environmental exposures may be key to asthma prevention," the investigators concluded, adding, "Other factors, however, likely contribute to marked Black-White disparities in major asthma morbidity (measured by hospitalizations) throughout childhood and beyond."
Asthma Associated With Memory Issues In Children
Study finds that asthma in children is linked to memory difficulties, with earlier onset potentially exacerbating the impact and extending to executive function challenges.
Study: Asthma and Memory Function in Children. Image Credit: bubutu/Shutterstock.Com In a recent study published in JAMA Network Open, doctors from the University of California Davis School of Medicine examined the potential link between childhood asthma and memory difficulties, especially in episodic memory.
They analyzed longitudinal data on cognitive and brain development in adolescents to compare memory and cognitive development in children with and without asthma. The findings indicated lower memory scores for children with asthma.
BackgroundAsthma is a prevalent chronic respiratory condition among children and manifests primarily through symptoms such as wheezing and breathing difficulties. However, recent studies on animal models have indicated that asthma could lead to neurological changes, including memory deficits.
In rodent models, asthma is associated with neuroinflammation and hippocampal injury, which impair memory functions. The hippocampus, crucial for episodic memory, appears especially vulnerable to inflammation and hypoxia from chronic respiratory conditions.
Research on childhood asthma has primarily focused on physical symptoms and has largely overlooked potential cognitive implications, especially related to memory and attention. The few studies that have examined cognitive differences reported that children with severe asthma have lower verbal memory than their peers.
However, confounding factors, such as socioeconomic background, make it challenging to attribute the cognitive deficits solely to asthma, and further research is needed to clarify whether asthma impacts memory and cognitive abilities in children.
About the studyThe present study utilized data obtained from the Adolescent Brain Cognitive Development study, a large, longitudinal assessment of brain development and cognitive health in children across the United States (U.S.) funded by the National Institutes of Health (NIH). The study enrolled children aged 9 or 10 years who were followed up over two years.
A history of asthma, identified through parent reports, was used to categorize the participants into three groups — children with early asthma onset, children with later onset asthma, and a comparison group consisting of children without asthma. The cross-sectional examination compared children with asthma to children without asthma at different assessment points.
Furthermore, the researchers measured cognitive performance using specific tasks from the NIH Toolbox, consisting of various neurological and behavioral assessments. The tasks were chosen based on their sensitivity to potential asthma-related deficits. Key assessments included the picture sequence memory test — a task measuring episodic memory dependent on hippocampal function. Pattern comparison processing speed test, which assessed processing speed, and the flanker inhibitory control and attention test to measure attention and response inhibition were also included.
Propensity score matching was used to match controls based on factors such as age, sex, and parental income. Additional analyses controlled for socioeconomic status to address potential confounding effects.
In the longitudinal analysis, linear growth models assessed changes in episodic memory, processing speed, and attention across time while considering age-related improvements. Additionally, for the cross-sectional analysis, the researchers used linear regression models to evaluate differences in cognitive performance between children with and without a history of asthma.
ResultsThe study found that children with asthma, particularly those with early-onset asthma, displayed slower memory development compared to their peers without asthma. More specifically, children with early-onset asthma showed lower improvements in episodic memory over time than the comparison group, suggesting that early and prolonged asthma could potentially impact memory development.
In contrast, children with later-onset asthma did not show significant differences in memory development rates compared to children without asthma. However, the cross-sectional analysis showed that children with any history of asthma performed worse than children without asthma on episodic memory, processing speed, and inhibitory control and attention tests.
These findings suggested that asthma may broadly affect cognitive functions and extend beyond memory to impact other executive functions. While previous studies in animals suggested that asthma-related brain inflammation might impair memory, this study presented evidence of similar patterns in children.
Furthermore, across both longitudinal and cross-sectional models, children with asthma showed consistently lower performance in memory and cognitive tasks, regardless of socioeconomic factors or race. These results supported the hypothesis that asthma, especially if experienced from an early age, could hinder cognitive development in children, potentially impacting academic and social skills as well.
ConclusionsTo summarize, the study reported a significant association between childhood asthma and slower development of memory and executive function in children. These findings highlighted the importance of understanding the cognitive impacts of asthma and its potential implications for managing academic and developmental outcomes in children with asthma.
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Exercise During Pregnancy May Cut A Child's Asthma Risk In Half
Wheezing, shortness of breath, tightness in the chest: the symptoms of an asthma attack can be scary, especially for children.
But, a new study suggests that pregnant women may have some agency over whether their child develops asthma.
Researchers from Finland found that the offspring of women who exercised at least three times a week during pregnancy were less than nearly half as likely to be diagnosed with asthma as the children of inactive women.
"We showed for the first time that it could actually also protect from asthma development," says Pirkka Kirjavainen, lead study author and a researcher at the University of Eastern Finland.
What causes asthma in children?Asthma affects nearly 25 million people in the United States, including 4.7 million children under the age of 18, according to the National Institutes of Health.
This chronic lung condition, which causes airway inflammation and constriction, can be diagnosed at any age. Each year, over 700,000 emergency room visits involve children with asthma, according to the Journal of the American College of Emergency Room Physicians.
While the exact cause of asthma remains unclear, and there is no cure, scientists know it often runs in families and have linked the condition to over 30 genes.
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Children with mothers and fathers who have asthma are three times and 2.5 times, respectively, more likely to develop the condition.
"The genetic predisposition is very strong," Kirjavainen says. "But even if you have the genetic predisposition, it depends upon the environmental factors whether you have the onset of asthma."
Factors such as prenatal antibiotic treatments, indoor pollutants, smoking, and being overweight can factor into the development of the disease in adults.
Socioeconomic factors can also play a significant role. Researchers supported by the National Institute of Environmental Health Sciences have found that adults living in neighborhoods with the most air pollution had the highest rates of asthma.
How can maternal exercise be protective?Fortunately, though, recent research suggests pregnant women may have some degree of control over whether their children develop asthma.
While women were once advised to avoid exercise during pregnancy to avoid the risk of premature labor or low birth weight, physical activity is now seen as beneficial for the well-being of both the woman and the fetus.
Moderate physical activity can help prevent excessive weight gain and gestational diabetes while supporting heart and lung health during pregnancy, according to the U.S. Centers for Disease Control and Prevention (CDC). The agency recommends healthy pregnant women get at least 150 minutes of moderate-intensity exercise per week, which can include brisk walking, bike riding, and yoga.
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Maternal exercise is also associated with better outcomes for the fetus. Studies have shown that regular physical activity with increased blood flow during pregnancy can result in better lung, heart, and cognitive development in the fetus.
Conversely, inactivity during pregnancy may lead to poorer health outcomes for children. A 2022 study by Norwegian and Swedish scientists found that the 3-month-old babies of women who reported being inactive during the first half of their pregnancy had greater odds of low lung function than those who said they were "highly active" during pregnancy.
The recent study expanded on these findings by analyzing 963 mother-infant pairs. Participants completed questionnaires in the first and third trimesters, which were used to assess their activity levels and their children's health outcomes. They found that pregnant women who exercised at least three times a week were 50 percent less likely to develop asthma than children of less active mothers.
Stephen Kimura, a board-certified allergist and immunologist based in Pensacola, Florida, says these findings were exciting, as they suggested an accessible way for pregnant women to potentially prevent the onset of asthma in their children.
"Nowadays, there's so much focus on treatment," Kimura says. "Once the child has asthma, there's so many medications out there and so many new biological injections that we can give to help treat the disease. So if we can identify the high-risk individuals and alter maternal care and decrease asthma, that would be great."
For example, Kimura says he'll see a child who has been diagnosed with asthma accompanied by a pregnant woman who wants to know what she can do to prevent asthma in the next child. He thinks it's great that he can now recommend something relatively easy, such as getting moderate exercise at least three times per week.
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How about women who may not be physically able to get 30 minutes of exercise five days a week during pregnancy? Study researcher and co-author Emma-Reetta Musakka of the University of Eastern Finland says there are many exercises pregnant women can do, even while seated.
"Our research nicely shows that it's better to do something than nothing," she adds.
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