ORIGINAL ARTICLE

Influence of family income on hospital visits for asthma among Canadian school children

R E Dales¹, B Choi², Y Chen³, M Tang³

¹ Department of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Health Research Institute, Ontario, Canada
² Surveillance and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Population and Public Health Branch, Health Canada, Ottawa, Ontario, Canada K1A 0K9
³ Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada

Correspondence to:
Correspondence to:
Dr R E Dales, Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Ontario, Canada K1H 8L6;
rdales{at}ottawahospital.on.ca

Background: A study was undertaken to investigate the mechanisms by which socioeconomic status may influence asthma morbidity in Canada.

Methods: A total of 2968 schoolchildren aged 5–19 years with reported asthma were divided into three family income ranges. Hospital visits and risk factors for asthma, ascertained by questionnaire, were compared between the three groups.

Results: The mean (SE) annual period prevalence of a hospital visit was 25.0 (3.1)% among schoolchildren with household incomes of less than $20 000 Canadian compared with 16.0 (1.3)% among those with incomes of more than $60 000 (p<0.05). Students with asthma from lower income households were more likely to be younger and exposed to environmental tobacco smoke and cats, and their parents were more likely to have a lower educational attainment and be unmarried (p<0.05). Across all income groups, younger age, lower parental education, having unmarried parents, and regular exposure to environmental tobacco smoke were each associated with an increase in risk of a hospital visit (p<0.05). No increased risk was detected due to sex, having pets, and not taking dust control measures. Although not statistically significant at p<0.05, there may have been an interactive effect between income and susceptibility to environmental tobacco smoke. In the lower income group those children who were regularly exposed to second hand smoke had a 79% higher risk of a hospital visit compared with a 45% higher risk in the higher income group. In a logistic regression model the association between income and hospital visit was no longer significant after adjusting for differences in reported exposure to passive smoking.

Conclusion: Socially disadvantaged Canadian schoolchildren have increased asthma morbidity. Exposure to cigarette smoke appears to be one important explanation for this observation.

Keywords: asthma; socioeconomic status; environmental tobacco smoke; hospital visits; school children

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• Chen, E, Miller, G E, Walker, H A, Arevalo, J M, Sung, C Y, Cole, S W (2009). Genome-wide transcriptional profiling linked to social class in asthma. Thorax 64: 38-43 [Abstract] [Full Text]  
• Hill, S C, Liang, L (2008). Smoking in the home and children's health. Tobacco Control 17: 32-37 [Abstract] [Full Text]  
• Spencer, N. (2005). Maternal education, lone parenthood, material hardship, maternal smoking, and longstanding respiratory problems in childhood: testing a hierarchical conceptual framework. J. Epidemiol. Community Health 59: 842-846 [Abstract] [Full Text]  
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