Individual and area-based indicators of socioeconomic status and childhood asthma

The current study evaluated the association between individual and area-based indicators of socioeconomic status and the prevalence, severity, and lifetime hospitalisation for asthma in children. The representative sample of 4,027 children from Rome, aged 6-7 yrs, used for the 1994 ISAAC (International Study on Asthma and Allergies in Childhood) initiative, was selected. Individual and small area indicators of socioeconomic status were used. Individual data on parents' education and on childhood asthma were gathered from self-administered parental questionnaires. Two small-area indicators (socioeconomic status index (SES) and average income in 1994) were derived using information available at the census tract of residence. Logistic regression models were used to estimate the association of parental education and small area indicators with asthma prevalence, severity, and hospitalisation. Parental smoking was considered in the analysis as a potential confounder. Prevalence of physician diagnosis of asthma (11.3%) increased as father's education decreased. Prevalence of severe asthma (1.6%) increased as maternal and paternal educational levels decreased. Lifetime hospitalisation for asthma (2.8%) was strongly associated with both parental education and small-area indicators of social disadvantage, even when considered simultaneously in the same logistic model. Socioeconomic conditions are associated with asthma occurrence, its severity, and hospitalisation. The association was stronger for asthma severity and hospitalisation. Individual indicators correlated better with the outcomes than area-based indicators. However, living in an underprivileged area is a strong independent predictor of hospital admission for asthma.