Metropolitan Phoenix ranks in the top five US cities for asthma-related deaths. Approximately 8% of the Phoenix population has asthma, and research conducted in a low-income Latino neighborhood found that 16% of children under 19 years old had been diagnosed by a doctor as having asthma; this is twice the national average.
Sara Grineski investigated the relationships between socioeconomic status, race, ethnicity, indoor hazards, ambient environmental hazards, and asthma hospitalization rates, to understand how these factors contribute to the incidence of childhood asthma and how families cope with childhood asthma.
The study asked:
- Do socio-spatial inequalities explain patterns in uncontrolled childhood asthma?
- How do parents have differential control of children’s asthma?
- How have historical and geographical processes influenced inequalities associated with asthma control?
Grineski mapped the incidence of children’s asthma hospitalizations by zip code and found that clusters of high-hospitalization rates were located in the center of the metropolitan area and along the freeways (Fig. 1). These areas correspond with concentrations of industries with high emissions levels and concentrations of minority populations (Fig. 2).
She used Poisson regression models to analyze what factors best predicted asthma hospitalizations. An analysis of socio-demographic factors only found that areas with lower social class and higher proportions of African Americans had significantly higher rates of uncontrolled asthma. However, the most important predictor of asthma hospitalizations was a composite pollution measure of three criteria pollutants: nitrous oxides (NOx), ozone (O3), and carbon monoxide (CO). Areas high in these criteria pollutants positively predicted areas of high hospitalization rates.
Differential Control of Asthma
The research contrasted family experiences with childhood asthma in two different areas: South Phoenix and Ahwatukee. South Phoenix has historically been marginalized. This process has resulted in distinct spatial, social, and economic segregation of undesirable land uses (such as polluting industries) and minorities from “Anglo” Phoenix. Ahwatukee is representative of newer, upper-class developments in metropolitan Phoenix, although it is geographically separated from the rest of the metropolitan area by South Mountain City Park. The City of Phoenix promotes the area as a series of master-planned communities with desert landscaping, golf courses, and lakes.
In-depth interviews with 53 parents of asthmatic children revealed the nexus of race, class, and place. Comparing families’ experiences in South Phoenix and Ahwatukee, the study investigated how access to, and control over, asthma resources differed between the two areas. Two important resources emerged as crucial for coping successfully with the disease: health care and the environment.
Major findings on healthcare were:
- Upper-income families in Ahwatukee were satisfied with their health insurance and health care, and their children received preventive care.
- Families with public health insurance were generally satisfied with their insurance but complained about getting approval for preventative medicines.
- Lower-income families with job-based insurance struggled with rising health-care costs, which affected their children’s health negatively.
- Uninsured families relied on the Phoenix Children’s Hospital Breathmobile for asthma care.
- Spanish-speaking parents reported a lack of translation services at some local emergency rooms.
Grineski, S. E. 2006. Social Vulnerability, Environmental Inequality, and Childhood Asthma in Phoenix, Arizona: A Report to the Community. Unpublished report (large file).
Grineski, S. E. 2006. Social Vulnerability, Environmental Inequality, and Childhood Asthma in Phoenix, Arizona. Unpublished Ph.D. thesis, Arizona State University.