For my job I've been doing some research on asthma prevalence and demographics. I thought that I would share some of the links I found and my summary on this condition that disproportionally effects low-income communities.
A word that all liberals should know and wield: externality. Based on the profit motive, the job of a corporation or industry is to maximize externalities. Even within the narrow confines of libertarian premises, a very strong argument can be made that one of government's principal roles is to minimize externalities. This case should be made in libertarian terms in order to broaden the coalition for strong regulation of pollution, amoung other liberal causes. I like to describe pollution as a government subsidy of free waste disposal. See below for details of just one societal cost of this subsidy.
Prevalence
There are estimated to be more than 300mil people in the world suffering from asthma:
* www.ginasthma.com/download.asp?intId=29
According to the American Academy of Asthma, Allergy, and Immunology (AAAAI) there were 20.3mil reported cases of asthma in the US, 9mil of them children. According to the Center for Disease Control (CDC) there were 29.8mil Americans who had been diagnosed at one time in their life with asthma in 2003 and 19.8mil presently diagnosed:
* www.aaaai.org/patients/resources/fastfacts/asthma.stm
* www.aaaai.org/patients/resources/fastfacts/childhood_asthma.stm
* www.cdc.gov/asthma/asthmadata.htm
Survey Accuracy
Due to the fact that the National Institutes of Health (NIH) health survey counts only diagnosed cases, estimates of national prevalence of asthma may undercount the actual prevalence of less severe cases, those which have not required emergency room visits, especially in uninsured communities since these folks may never be diagnosed. Moreover, asthma is under-diagnosed even in economic classes privileged with health insurance, since it can be mistaken for bronchitis, bronchiolitis or pneumonia:
* www.cdc.gov/asthma/NHIS/
Socioeconomic Factors
Because of insufficient regulatory control over pollution, the rate of asthma is higher among low-income populations, which are disproportionately minority, more likely to live near industrial areas:
* health.yahoo.com/news/141964
* www.aaaai.org/patients/resources/fastfacts/asthma_demographics.stm
Because many low-income people cannot afford health insurance and because there is still a correlation between class and race, the quality of asthma treatment varies dramatically along racial lines. For example, black Americans are less likely to receive outpatient treatment for asthma despite having a higher prevalence, yet they are much more likely to have emergency room visits or hospitalization for asthma and 3 times as likely to die from an asthma attack compared to whites. This indicates that the prevalence of "severe persistent" asthma is greater in low-income communities compared with communities privileged with access to treatment. However, if the study calls for subjects that are symptomatic despite specific treatments, such as LCS and LABA inhalers, then a population that has had access to treatment must be targeted:
* www.nhlbi.nih.gov/resources/docs/04_chtbk.pdf(p. 62)
* www.cdc.gov/nchs/products/pubs/pubd/hestats/asthma/asthma.htm
Geographic Distribution
There are not data available for the entire United States. However, reasonable inferences can be made from examining the socioeconomic data, considering the environmental factors contributing to asthma and examining local and regional studies of the geographic distribution of asthma. Indeed, the available geographic data reinforce the conclusions drawn from aggregate demographic data, and show that even within cities there are asthma clusters relating to environmental risk factors.
A 2003 study of asthma in New York City found that asthma prevalence was highest in Manhattan, a borough that though generally wealthier includes Harlem and includes high traffic, and lowest in Long Island, a less congested suburb. The New York study found that high asthma rates occurred in clusters, further reinforcing the conclusion that high prevalence results from environmental factors:
* inform.nu/Articles/Vol6/v6p089-099.pdf
A more detailed 2005 study of asthma in Buffalo obtained even stronger and more reliable results. Researchers studied differences in rates of hospitalization between asthma and gastroenteritis, in order to isolate the effect of air pollution on the asthma rate. That is, by comparing rates between asthma and a condition not subject to variance with air quality, researchers were able to isolate the effect of air quality on asthma from other factors thus supporting an inference of causation over and above correlation. Researchers found that the asthma rate was higher compared to gastroenteritis in regions of Buffalo marked by increased levels of particulate matter, again showing clusters correlated with pollution:
* www.ij-healthgeographics.com/content/4/1/14
The Associated Press has compiled a list of the counties with and factories creating the most pollution. This may be a helpful guide to finding higher patient populations with "severe persistent" asthma.
* health.yahoo.com/news/141964 (scroll to bottom)
From the above discussion it is reasonable to conclude that concentrations of asthma will correlate with concentrations of poverty and pollution. There is likely a rough fit between maps of pollution and maps of asthma:
* creativemethods.com/airquality/maps/united_states.htm
More Sources
The following sources provide or link to more detailed demographic data on asthma, including evidence of increasing prevalence over the past several decades:
* www.cdc.gov/asthma/asthmadata.htm
* www.aaaai.org/patients/resources/fastfacts/
* www.cdc.gov/asthma/NHIS/NHIS2003Data.htm