摘要：Objectives. We examined racial and ethnic disparities in the total potential burden of asthma in low-income, racially/ethnically heterogeneous Chicago schools. Methods. We used the Brief Pediatric Asthma Screen Plus (BPAS+) and the Spanish BPAS+, validated, caregiver-completed respiratory questionnaires, to identify asthma and possible asthma among students in 14 racially/ethnically diverse public elementary schools. Results. Among 11490 children, we demonstrated a high lifetime prevalence (12.2%) as well as racial and ethnic disparities in diagnosed asthma, but no disparities in prevalences of possible undiagnosed asthma. Possible asthma cases boost the total potential burden of asthma to more than 1 in 3 non-Hispanic Black and Puerto Rican children. Conclusions. There are significant racial and ethnic disparities in diagnosed asthma among inner-city schoolchildren in Chicago. However, possible undiagnosed asthma appears to have similar prevalences across racial/ethnic groups and contributes to a high total potential asthma burden in each group studied. A better understanding of underdiagnosis is needed to address gaps in asthma care and intervention for low-income communities. Asthma is one of the most common chronic illnesses of childhood. It is also unequally distributed among children of different races and ethnicities. Recent national survey data indicate an overall asthma prevalence of 12.2% for children younger than 18 years. 1 These data reveal dramatic differences in the prevalence of lifetime asthma by racial/ethnic group: among Hispanics, Puerto Ricans have the highest lifetime asthma prevalence (19.6%), more than 3 times the prevalence for Mexicans (6.1%). These prevalences bound those for non-Hispanic Blacks (13.8%) and non-Hispanic Whites (11.1%). 2 As alarming as these proportions are, they likely underestimate the prevalence of asthma among racial/ethnic subpopulations, as asthma appears to be highly prevalent among those segments of the population—for example, in minority children of low socioeconomic status living in urban areas 1 , 3 – 14 —in which symptomatic children often go undiagnosed. 4 – 7 , 10 – 12 , 14 – 16 This problem of underdiagnosis has limited the ability of administrative and other secondary data analyses (such as those using Medicaid or Medicare data, or the National Health Interview Survey) to yield accurate subpopulation estimates. Recent primary data collection efforts have tried to address this problem and have attempted to estimate the total potential burden of asthma by surveying respondents about asthma-related respiratory symptoms in addition to diagnosed asthma. 4 , 5 , 7 , 8 , 10 , 11 However, methodological inconsistencies among studies have produced varying prevalence estimates. This is to be expected given the considerable challenges faced by any study of an underdiagnosed condition, which include minimizing bias in the sample selected for study, using survey-based measures that have been validated against physician evaluations, translating and revalidating measures for use with non–English-speaking populations, and imposing consistent definitions of racial and ethnic subgroup membership. We report the prevalence findings of an ongoing research project examining both the prevalence and correlates of asthma among Chicago public-school children. We examined racial and ethnic disparities in the total potential burden of asthma, including possible undiagnosed asthma, by surveying the caretakers of children in 14 low-income, racially/ ethnically heterogeneous Chicago neighborhood public elementary schools. School-based surveys such as this have been shown to be a feasible means of ascertaining childhood asthma cases. 7 , 10 , 12 , 17 – 24 Our study has multiple strengths: (1) We employed a population-based sampling strategy that minimizes sample bias within the schools and neighborhoods selected; (2) We surveyed a large number of children across all elementary school grades in 14 neighborhoods; (3) We achieved a high response prevalence; and (4) We employed English- and Spanish-language survey measures of symptomatology that were validated against a professional medical evaluation. Our research design allowed us to accurately estimate the prevalence of asthma in specific racial/ethnic subgroups of children, as well as to estimate the total potential burden of asthma, in a medically vulnerable population of predominantly low-income, urban-dwelling children of diverse ethnicities.
