The Association between Residential Crowding and Asthma in Children in NHANES 2005-2006 Open Access

Isenburg, Jennifer Lynn (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/1z40kt04c?locale=en
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Abstract

Context: Asthma is a chronic disease affecting the respiratory system and characterized by airflow obstruction and bronchial hyperresponsiveness. Exposures to certain risk factors for asthma stemming from the indoor environment have been documented to both exacerbate and increase risk of the disease. Several studies suggest the association between crowding and asthma is either null or inversely related. However, these studies use a myriad of definitions for calculating density and show even more variation when setting threshold levels of density for establishing crowding.

Objectives: Our objective was to review the multitude of methods for calculating crowding and to establish a method of calculating crowding that best relates the numerator and denominator to risk factors for asthma. We then hoped to establish a threshold value that is most representative of crowding in the population. Using these we related the prevalence of asthma to this new variable for crowding.

Methods: We identified 4,777 subjects under the age of 20 in the National Center for Health Statistics of the Centers for Disease Control and Prevention's (NCHS/CDC) National Health and Nutrition Examination Survey (NHANES) two-year cycle from 2005-2006. We determined prevalence of asthma from interview variables and created a crowding variable from selected demographics collected on subjects. The density equation used for the study was people per room and the threshold for crowding was anything greater than or equal to the mean value for the population (mean=0.71). Odds ratios were examined using logistic regression procedures and accounting for weighting factors.

Results: Crowding was prevalent in 46% of asthma cases. Crowding was significantly associated with asthma in a logistic model adjusted for home age and subject age (OR=1.629, 95% CI: 1.054, 2.517).

Conclusions: The results of this study suggest that certain measures of crowding, such as the ones used here, may be associated with asthma while others may not. Many of the previous studies were conducted in countries that may not be comparable with one another so differences may be observed based on the population attitudes towards crowding. Further sensitivity analysis on multiple methods of calculating crowding and its associations with asthma may be warranted.

Table of Contents

Introduction.........................................................................1

What is Crowding?...................................................................1

Common Health Effects of Crowding...........................................5

Asthma...................................................................................7

Literature Review.....................................................................9

Goals...................................................................................12

Methods..............................................................................13

National Health and Nutrition Examination Survey (NHANES).......13

Inclusion/Exclusion Criteria.....................................................13

Exposure Variable..................................................................14

Outcome Variable..................................................................15

Covariates............................................................................15

Statistical Software Used........................................................17

Analysis...............................................................................17

Results...............................................................................19

Discussion..........................................................................22

Importance for Future Health..................................................23

Future Research....................................................................23

References..........................................................................25

Tables and Figures ..............................................................29

Tables..................................................................................29

Figures.................................................................................41

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