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Undercounting and Undertreating the Underserved

Diane E. McLean, MD, PhD, MPH; Shawn Bowen, MD; Karen Drezner, MEd; Amy Rowe, PNP; Peter Sherman, MD; Scott Schroeder, MD; Karen Redlener, MS; Irwin Redlener, MD

Arch Pediatr Adolesc Med. 2004;158:244-249.

Background  In the United States, children of color, children who live in urban medically underserved communities, and children whose families have limited economic resources have excessively high rates of asthma. The identification of high-risk subgroups of underserved children is crucial for understanding the determinants and scope of the childhood asthma epidemic and for developing successful interventions.

Objective  To determine the population prevalence of asthma among homeless children.

Design  Cross-sectional study.

Setting  Three family shelters in New York City.

Participants  A total of 740 children whose families entered 3 family shelters from June 30, 1998, to September 18, 1999.

Main Outcome Measures  Prior physician asthma diagnosis, current asthma symptoms using National Asthma Education and Prevention Program symptom criteria, current medications, and emergency department use in the past year.

Results  Of the children, 26.9% had a prior physician diagnosis of asthma. In addition, 12.9% of the children without a prior physician diagnosis of asthma reported symptoms consistent with moderate or severe persistent asthma. Overall, 39.8% of homeless children in New York City are likely to have asthma. Few children with persistent asthma received any anti-inflammatory treatment. Almost 50% (48.6%) of children with severe persistent asthma had at least 1 emergency department visit in the past year; 24.8% of children with symptoms of mild intermittent asthma had at least 1 visit.

Conclusions  The prevalence of asthma among a random sample of homeless children in New York City is likely to be 39.8%—more than 6 times the national rate for children. Asthma in homeless children is also likely to be severe and substantially undertreated.

From the Department of Psychiatry, Columbia University/New York State Psychiatric Institute (Dr McLean), New York City; the Division of Community Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine (Drs McLean, Bowen, Sherman, and Schroeder and Mss Drezner, Rowe, and K. Redlener); and the Department of Population and Family Health, Columbia University (Dr I. Redlener).

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