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GBlist: Asthma, roaches, and the urban poor



Most Serious Youth Asthma Cases Linked to Roaches, Study Finds

Among Urban Poor, Exposed Children More Likely to Be Hospitalized

 By Curt Suplee Washington Post Staff Writer Thursday, May 8 1997; Page A12
The Washington Post 

 The common cockroach is not only a major cause of the growing asthma
epidemic among America's poorest inner-city youth, but apparently prompts a
majority of the most serious cases, a new multi-regional study has found.

 In today's issue of The New England Journal of Medicine, scientists report
that when they examined hundreds of severely asthmatic young children from
eight densely populated urban centers -- including Washington and Baltimore
-- they discovered that those allergic to cockroaches and heavily exposed to
the insects at home were three times more likely to be hospitalized than
other asthmatic youth.

 "While people have always known that cockroach [allergy] is an important
causal agent, the magnitude of it wasn't appreciated until now," said
Columbia University pulmonary specialist Robert B. Mellins, president of the
American Lung Association of New York. "Nor was the fact that it was more
important than other factors" in many of the worst cases.

 "In inner-city populations, this is highly significant," said study
co-author Floyd J. Malveaux, dean of the college of medicine at Howard
University. "The exposure is greater wherever there is crowding."

 Asthma is a debilitating respiratory condition that strikes about one child
in 10 in the United States. Most instances result from viral infections,
irritants such as tobacco smoke, or strong allergic reactions to mold,
animal dander, dust mites, pollen or other allergens -- including the feces,
saliva and body parts of cockroaches.

 The incidence and severity of asthma has increased dramatically during the
past 35 years in several countries throughout the world, where it is often
prominent in affluent populations. In the United States, however, the
greatest prevalence occurs in poor, inner-city children, who are
approximately three times as likely to be hospitalized or die from the
disease as their suburban counterparts.

 That situation has led scientists to try to identify environmental factors
that may be playing a role. For the past five years, researchers from the
National Cooperative Inner-City Asthma Study have been analyzing data from
more than 1,500 asthmatic children nationwide, under the sponsorship of the
National Institute of Allergy and Infectious Diseases.

 In the study published today, investigators focused on a subset of 476
asthmatic children aged 4 to 9 in neighborhoods where at least 30 percent of
household incomes were below the poverty level.

 The children -- 78 percent of whom are black -- were given skin tests to
assess their allergic reactions to material from cats, dust mites and
cockroaches. In addition, during the 1992-93 study period, their homes were
examined, their mattresses and bedding were sampled, and their bedroom
floors were vacuumed to determine the principal allergens present.

 High levels of cockroach allergen showed up in 50.2 percent of the
bedrooms, whereas only 12.6 percent had high levels of cat dander and 9.7
percent exhibited high levels of dust-mite allergens. Skin tests revealed
that 36.8 percent of the children were allergic to cockroaches; in contrast,
34.9 had reactions to dust mites and 22.7 were allergic to cats.

 The scientists then reviewed health histories and found that those children
who were both allergic to cockroaches and highly exposed to the insects were
hospitalized 3.4 times as often as the other children studied. That group
also was 80 percent more likely to have unscheduled medical visits for asthma.

 "They also had significantly more days of wheezing, missed school days and
nights with lost sleep, and their parents or other caregivers were awakened
during the night and changed their daytime plans because of the child's
asthma more frequently," the researchers wrote.

 So far, no one knows exactly how cockroaches or any allergens are
implicated in the rising incidence of inner-city asthma cases. But in an
editorial accompanying the study, physicians from the University of Virginia
and Emory University cite changes in housing conditions over the past three
decades that might contribute to allergen exposure, including "higher
temperatures in damp houses, decreased ventilation after the energy crisis
[in the 1970s] and the use of more upholstered furniture and carpets. In
addition, people were spending progressively more time indoors."

 Numerous experts emphasized yesterday that relatively small expenditures in
cockroach control could pay substantial public-health dividends. The
editorial urges that the public "focus on reducing the population of
cockroaches [through] control of sources of food and water, routine
cleaning, and regular use of insecticides."

 Although the insects are "an omnipresent problem in the city," the D.C.
government does not have "any structure in place to deal with this
particular problem," said Richard A. Levinson, administrator of preventive
health services for the city's Department of Health. But "with asthma
increasing throughout the country, it is our intention to be more active" in
educating the public, he said. One effort, an "asthma awareness event" in
conjunction with Howard University, is planned for the fall, and "we'll
certainly deal with the issue of allergens and their control," Levinson said.

 ASTHMA RATES

 The cockroach research comes after a decade of significant increases in
youth asthma rates. The problem is most acute in cities.

 Cases per 1,000 Americans under 18: 69.0

 Cases per 1,000 Americans, 1994

 Central city: 62.2

 Outside central city: 52.8

 SOURCES: American Lung Association, National Center for Health Statistics

 © Copyright 1997 The Washington Post Company

Hal Levin         <hlevin@cruzio.com>

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