Asthma and its Relation to an Urban Atmosphere

by Kristle Grell
 

Increased asthma rates among Blacks attributed to an urban atmosphere, not race.

   Asthma rates have shown a sharp increase in the United States over the last fifteen years, increasing by over 160% in children under five years old. Due to the multitude of factors that are involved, the reason for this rise is still unclear. Among the theories suggested are genetic predisposition and environmental exposures, including allergens, both outdoor (molds, pollen, etc) and indoor (dust mites, cockroaches, etc.), tobacco smoke, and pollutants, especially ozone and particulate matter .1 Although asthma is not race-specific, it is quite evident that Blacks are much more affected, compared to Whites. It appears that this racial disparity is due to differences in environmental exposures, for genetics solely cannot explain the sudden rise within recent years. Considering that the majority of residents in poor, inner-cities are disportionately Black, and that asthma is most prevalent in these areas, it is highly possible that poverty and urban residence, rather than race itself, are the underlying factors responsible for the differences in asthma rates among populations.2
    This hypothesis was tested by Andrew Aligne, Peggy Auinger, Robert Byrd, and Michael Weitzman, in a paper entitled, " Risk factors in pediatric asthma: contributions of poverty, race, and urban atmosphere ." In unadjusted analyses between black and white children, it was found that Blacks had comparatively higher rates of asthma. However, after controlling for numerous factors, it was shown that "black race was not a significant correlate of asthma.

Compared with nonurban white children, urban children, both black and white, were at significantly increased risk of asthma", more so than nonurban black children.3 In a similar fashion, results indicated that urban children, both poor and nonpoor, had much higher asthma rates, compared to nonurban nonpoor children: urban poor children did not show such elevated rates. These findings therefore seem to indicate that the disparity in asthma rates among Blacks and Whites has less of a correlation with racial or economic factors, and more to do with their place of residence, considering that "all children living in an urban atmosphere demonstrated an increased risk for asthma"4
 


 
 
 
 

Which aspect of urban living is responsible for increased asthma rates?

    A number of factors can be attributed to elevated rates of asthma among urbanites. These include, but are not limited to "passive smoking, outdoor pollutants, substandard housing, increased time indoors, poor diet, decreased access to health care, and exposure to cockroaches." 5Even though the precise cause is currently unknown, urban living itself, as an independent factor, rather than race, seems to coincide with asthma being "a disease of modern civilization." 6 Furthermore, asthma rates among black Africans are very low, and when it does occur, it is attributed to urbanization/industrialization. Other evidence shows that individuals from countries such as India and Malaysia-countries with low levels of asthma-who immigrate to countries with a high incidence of asthma, such as England or Australia, seem to, within a few decades, develop asthma rates similar to the country to which they immigrated, again pointing to asthma as a "consequence of exposure to a modern, urban environment." 7.

Outdoor pollutants associated with asthma

    Among the pollutants that contribute to asthma are nitric oxide, ozone, particulate matter, and sulfur dioxide, which are commonly emitted from industrial processes and motor vehicles. In poor, urban neighborhoods, such as North Brooklyn, "high-density industry is located alongside residential housing, and thousands of diesel tractor trailers rumble through the streets each day.8 However, many, including Michael Fumento, express doubts concerning asthma and its correlation to environmental pollutants. In an article in the Investor's Business Daily, he argues that while asthma rates have been sharply rising, outdoor pollutants have been decreasing.

Source: EPA
 

As further evidence, he points to a comparative study between "asthma rates in highly polluted Leipzig, then East Germany, and the far cleaner Munich in West Germany, which found asthma rates lower in the East." 9 According to Mr. Fumento, the number of asthma cases has been rising, not because of outdoor pollutants, but due to indoor ones-a result of better insulation in homes after energy prices surged during the 1970's. As a result, "with less fresh air circulating into these 'tighter' homes, indoor pollutants such as cooking byproducts, pet dander, tobacco smoke, hairspray, and insect droppings were more likely to build up." 10
    According to the EPA, even though air quality for the six principal pollutants has shown improvements over the past two decades, over 170 million tons of pollution are emitted yearly in the United States.11 In addition, over 142 million people, including New Yorkers, reside in counties whose air quality was deemed unhealthy in the American Lung Association's State of the Air: 2002 , due to high levels of ozone and particulate matter.12
 

                                Of the 10.2 million American adults with asthma who live in counties with
                                ozone monitors, 7.6million-more than 70%-lived in counties that received
                                an 'F' rating in ozone pollution. Of the 2.6 million children living in counties
                                with monitors who had an asthma attack last year, 1.9 million-more than
                                70%-live in counties receiving an 'F' rating.
                                                                                            Source: State of the air:2002

Suburban and rural communities are not immune

    Even though urban areas are known for their high levels of pollution, suburban and rural communities are not immune. Even without major industry or large populations, these areas can also encounter pollution blown in from other communities.13
    Atlanta, referred to as the New York City of the South, is among the worst air quality regions in the nation. However, this problem is not specific to those who live in the city-for the suburb of Gwinnett County , according to the American Lung Association, beat even New York City as being "one of the nation's worst air-quality offenders."14 This can be attributed both to the over 3 million registered automobiles in the area, as well as Georgia's long growing season, producing pollen 10 months/year. These factors clearly have negative effects on asthmatics, but considering that nothing can be done to prevent the environmental allergens, pollution must be targeted. In the Journal of the American Medical Association, the CDC reported a "'42 percent decrease in asthma-related emergency room visits during the 1996 Summer Olympics.' For one whole month, the populace of Gwinnett County altered travel methods and kept many automobiles off the roads."15
Why are there counties in New York with high levels of ozone, but low rates of asthma?
Data from the American Lung Association shows that all boroughs within New York City received a grade of "F" when it comes to unhealthy amounts of ozone. However, while the number of asthma cases in poor, urban areas such as Brooklyn and the Bronx are increasingly high, other areas, including Staten Island, Richmond County, (which has the worst air quality in the state), possess comparatively much lower levels.16 This seems to suggest that environmental pollutants are not a sole cause of asthma, with other factors of urban living, including indoor pollutants (due to disparities in housing conditions) playing a further role.


 
 
 

References

1. EPA. " Asthma and the environment: a strategy to protect children. " May, 2000.
2. Andrew Aligne, Peggy Auinger, Robert Byrd, and Michael Weitzman. " Risk factors for pediatric asthma- Contributions of poverty, race, and urban residence ."
3. Ibid
4. Ibid
5. Ibid
6. Ibid
7. Ibid
8. John C. LaRosa, MD. " SUNY Downstate-Asthma: Letter from the President ".
9. Fumento, Michael. EPA's Pollution-Asthma Theory is full of Bugs ." May 27th, 1997.
10. Ibid
11. EPA. National Air Quality:2001 .
12. The American Lung Association. " State of the Air:2002 ."
13. Ibid
14. Joni Strandquest. Points North. " Going from Bad to Worse ." August, 2001.
15. Ibid
16. Infoshare