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Asthma Study Prompts Questions About Health Care

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A federal study that shows black children die from asthma at a higher rate than white children demonstrates that many African-American families lack adequate medical care, child-health experts and educators said last week.

But Carol Johnson, the primary author of the CDC report, said the higher incident rate among young black children is not readily explained.

Ms. Johnson, an epidemiologist with the federal Centers for Disease Control and Prevention in Atlanta, said the climbing mortality rate for all children may be due, in part, to improved diagnosis and better reporting of the disease over the past decade. "It may also be connected to socioeco-nomics," she said of the higher death rate for black children, "but we should look further to see what is going on."

Between 1980 and 1993, asthma deaths among people under age 24 in the United States increased 118 percent, according to the report released this month. But in every age category, black children died from asthma at a higher rate than their white counterparts.

From birth to age 4, blacks were six times more likely than whites to die from asthma in 1993, the study found. During the same year, black children between 5 and 14 were four times more likely than their white peers to die from the condition.

Asthma is the most common chronic disease in childhood and one of the leading causes of absences from school, according to the American Academy of Pediatrics in Elk Grove Village, Ill. In 1994, 4.8 million out of the 68 million U.S. children younger than 18 reported having asthma attacks.

Though there is no known cause, the illness--a lung disorder in which air tubes become inflamed and stifle breathing--is thought to have a genetic component and also may be triggered by respiratory infections in childhood, according to the CDC researchers.

Asthma attacks are aggravated by environmental factors, such as inadequate ventilation in housing, household dust mites, and tobacco smoke. Molds and other allergens, including cockroach antigens, can trigger bouts of coughing and wheezing in asthmatics, as can stress.

Doctors often treat asthma patients with anti-inflammatories and inhalers that decrease swelling and open clogged breathing tubes. But if the condition goes untreated, it can quickly become life-threatening.

Poverty and Pollutants

Some education groups and child-health experts said last week that the report clearly underscores the fact that many black families lack adequate health insurance and, as a result, fail to seek medical assistance until a condition is serious.

"Minorities don't get access to providers oftentimes, and they don't get continuity of care," said LeRoy M. Graham, a pediatric lung specialist in Atlanta who is affiliated with the American Lung Association.

"The sad tragedy is that 90 percent of asthma deaths are preventable," Mr. Graham said.

"If these children could have gotten health care, they wouldn't have died," said Stan Dorn, the director of the health division for the Children's Defense Fund, a child-advocacy group based in Washington.

Mr. Dorn said toxic environmental hazards such as lead paint and air pollution prevalent in many poor urban areas that are predominantly African-American also may help explain the higher asthma mortality rate among black children.

Gwendolyn J. Cooke, the director of urban services for the 43,000-member National Association of Secondary School Principals in Reston, Va., said that the CDC study is disturbing because when children arrive at school they should be healthy and prepared to learn.

"A child who comes wheezing into class can't concentrate and can't achieve," she said.

Ms. Cooke said that better education about the causes of health problems such as these is needed in schools and that the community-based health centers that many poor inner-city residents rely on need to redouble their efforts to identify and treat asthma.

Deaths From Asthma

The federal Centers for Disease Control and Prevention in Atlanta has released a report documenting an increase in deaths and hospitalizations linked to asthma, the most common long-term childhood illness in the United States.

The disorder is characterized by wheezing, coughing, and breathing difficulty and has been associated with socioeconomic and environmental factors, among others. These include outdoor air pollutants such as ozone and sulfur dioxide, indoor pollutants such as tobacco smoke, and allergens such as dust mites. According to the CDC report:

  • From 1980 to 1993, the asthma death rate among all people from birth to age 24 increased 118 percent, from 1.7 deaths per million to 3.7 deaths per million.
  • Blacks ages 15 to 24 had the highest asthma death rate: From 1980 to 1993, it increased 129 percent, jumping from 8.2 deaths per million to 18.8 deaths per million. The corresponding rate for whites in that age group increased 125 percent but involved far fewer deaths: In 1980, the rate was 1.6 deaths per million; by 1993, it had increased to 3.6 per million.

SOURCE: The Centers for Disease Control and Prevention.

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