The Disproportionate Burden Of Asthma By Race, Sex, Income And Education

This paper seeks to understand the relationship of county level median air quality with adult asthma risk, and the disproportional adult asthma risk by sex, race, income and education, controlling for individual and county effects. The specific objectives of this work are to answer the following questions: 1) What is the difference exposure of the median AQI by race, controlling for county and individual effects? 2) What is the difference in exposure of the median AQI by sex, controlling for county and individual effects? 3) What is the difference in exposure of the median AQI by education, controlling for county and individual effects? 4) What is the difference in exposure of the median AQI by income, controlling for county and individual effects? 5) Is the variation in asthma prevalence associated with county level median air quality? 6) Does the relationship between asthma prevalence and county level air quality vary by race, sex, education or income? Guided by an environmental justice framework, this study includes three sources of data: the Behavioral Risk Factor Surveillance System 2011 (BRFSS), EPA’s Air Quality System (AQS) database 2010, and the 2010 US Census. The associations between adult asthma risk and individual and county level variables are assessed using median AQI quartiles, ttests, confidence intervals and logistic regression. The results indicate that county level median air quality is associated adult asthma risk, but other county level variables are not significant, controlling for county and individual effects. The logistic regression results also indicate that the individual level factors of having a health plan, smoking, sex, age and annual household income greater than $15,000 have an association with adult asthma risk, controlling for county and individual effects. Furthermore, sex, education and income stratifications show racial differences in adult asthma risk, controlling for county and individual effects. The complex results of these findings underline the multifaceted nature of asthma risk, the importance of individuals having equal access to a healthy environment, and the need for finer-grain, longitudinal studies to determine relationships between individual and county level determinants in order to reduce asthma risk