Asthma diagnosis and treatment
Variation in total and specific IgE: Effects of ethnicity and socioeconomic status

https://doi.org/10.1016/j.jaci.2004.12.1138Get rights and content

Background

Asthma is common in minority and disadvantaged populations, whereas atopic disorders other than asthma appear to be less prevalent. It is unclear whether the same holds true for objective markers of sensitization.

Objective

To determine the association of asthma, atopic disorders, and specific sensitization with race and socioeconomic factors.

Methods

We analyzed total and specific IgE among 882 women (577 white, 169 black, and 136 Hispanic) who delivered a child at a large tertiary hospital in Boston, Mass, and who were screened for participation in a family and birth cohort study. Race/ethnicity and other characteristics were obtained from screening questionnaires. Addresses were geocoded, and 3 census-based geographic area socioeconomic variables were derived from block group information from the 1990 US Census.

Results

Black and Hispanic women were more likely to come from areas with low socioeconomic indicators and were more likely to have asthma than white women. However, these women were less likely to have hay fever and eczema than their white counterparts. Compared with white women, black women had higher mean total IgE levels; had greater proportions of sensitization to indoor, outdoor, and fungal allergens; and were more than twice as likely to be sensitized to ≥3 aeroallergens.

Conclusion

The racial/ethnic disparities in atopic disorders may represent either underdiagnosis or underreporting and suggest that allergy testing may be underused in some populations. Differences in total IgE levels and specific allergen sensitization are likely a result of the complex interplay between exposures associated with socioeconomic disadvantage.

Section snippets

Methods

This study involves women who delivered a child at a large tertiary hospital in Boston, Mass (Brigham and Women's Hospital). These women were screened for participation in the Epidemiology of Home Allergens and Asthma Study, which has previously been described.3, 14, 15 This analysis includes the 478 (95.8%) mothers enrolled in the study who had blood available for IgE measurements (377 white, 54 black, 26 Hispanic, 17 Asian, and 4 other). These subjects were the basis of previous reports.12, 13

Characteristics

Table I shows the baseline characteristics of the 882 women in this analysis. White women tended to be slightly older than black or Hispanic women. Black and Hispanic women tended to come from areas within the Boston city limits and areas with low socioeconomic indices. A greater proportion of black and Hispanic women cited Medicaid as their health insurance coverage compared with white women. Although the proportion of ever smoking was similar among the 3 groups of women, there were more black

Discussion

The main findings of our analysis are that black and Hispanic women have higher levels of total serum IgE and are more likely to be sensitized to a greater number of aeroallergens than white women. These findings remained significant after adjustment for area socioeconomic indicators. Our findings are supported by a geostatistical analysis (kriging) detailed in the Online Repository (www.mosby.com/jaci). Our kriging analysis showed that subjects living within the city limits of Boston had

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    Supported by grant AI 35786 from the National Institutes of Health.

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