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PEDIATRICS Vol. 107 No. 6 June 2001, p. e98
Received Oct 3, 2000; accepted Jan 29, 2001.
,
From the * Children's Hospital Medical Center, Cincinnati,
Ohio; Context. Residential exposures are
recognized risk factors for asthma, but the relative contribution of
specific indoor allergens and their overall contribution to
asthma among older children and adolescents in the United States are
unknown.
Objective. To estimate the relative contributions,
population-attributable risks, and costs of residential risk factors
for doctor-diagnosed asthma.
Design. Nationally representative, cross-sectional survey
conducted from 1988 to 1994.
Setting and Participants. A total of 5384 children who
were 6 to 16 years old and participated in the National Health and
Nutrition Examination Survey III, a survey of the health and
nutritional status of children and adults in the United States.
Main Outcome Measure. Doctor-diagnosed asthma, as reported
by the parent.
Results. Five hundred three of 5384 children and
adolescents (11.4%) had doctor-diagnosed asthma. After adjusting for
age, gender, race, urban status, region of country, educational
attainment of the head of household, and poverty, predictors of
doctor-diagnosed asthma included a history of allergy to a pet (odds
ratio [OR: 2.4; 95% confidence interval [CI]: 1.7, 3.3), presence
of a pet in the household (OR: 1.5; 95% CI: 1.1, 2.1), and immediate
hypersensitivity to dust mite (OR: 1.5; 95% CI: 1.05, 2.0),
Alternaria (OR: 1.9; 95% CI: 1.3, 2.8), and cockroach
allergens (OR: 1.4; CI: 1.04, 1.9). Family history of atopy (OR: 1.7;
95% CI: 1.1, 2.7) and diagnosis of allergic rhinitis (OR: 2.1; CI:
1.1, 3.7) were also predictors for asthma. The population-attributable
risk of having 1 or more residential exposures associated with
doctor-diagnosed asthma was 44.4% (95% CI: 29-60), or an estimated 2 million excess cases. The attributable cost of asthma resulting from
residential exposures was $405 million (95% CI: $264-$547 million)
annually.
Conclusions. The elimination of identified residential
exposures, if causally associated with asthma, would result in a
44% decline in doctor-diagnosed asthma among older children and
adolescents in the United States.
Department of Pediatrics, University of Rochester School of
Medicine, Rochester, New York; and § Battelle Memorial Institute,
Columbus, Ohio.
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