Healthy for Whom? Why do some Utah kids struggle harder to breathe?
This is the third part of a series of stories about health disparities by geography in Utah.
Part 1: The west side: Where an ill wind blows
Karina Contreras vividly remembers watching her daughter’s parched lips turn purple and the rapid rise and fall of her stomach as she battled to breathe.
Between the ages of 1 and 3, Karime was hospitalized about 10 times for asthma. Once, she spent two weeks in a hospital bed, taking oxygen every two hours along with medicine to relax the constricted passages to her lungs, her mother said.
“I was afraid she was going to die,” Contreras recently recalled.
Families who live in Contreras’ ZIP code on the west side of Salt Lake City, 84116, experience that sickening fear more often than parents living almost anywhere else in Utah, according to an analysis of Utah Department of Health data requested by The Salt Lake Tribune.
Children living in certain Salt Lake County ZIP codes — mainly west of Interstate 15 — are more likely to seek care in an emergency room and be hospitalized for asthma than those living in the rest of the state.
For example, children under age 4 living in the southwest part of Salt Lake City, including Glendale and Poplar Grove, are more than three times as likely to be treated and released for asthma in the ER than the state average. They’re 14 times as likely as children in parts of Orem.
Children living in Tooele County, the west side of West Valley City and the northwest part of Salt Lake City, including Rose Park,are about twice as likely than those living in the rest of the state to be admitted to the hospital for asthma — and eight times more likely than children in Cedar City.
Contreras still doesn’t know what triggered her daughter’s attacks, she said in Spanish. She’s just hoping the now 10-year-old will grow out of the lung disease.
Utah public health officials are also in the dark about why asthmatic children in some neighborhoods struggle to breathe more than others. Unlike officials in states like California and Michigan, Utah doesn’t look at disparities among people who check into hospitals.
The reasons families head to the ER can be complex: Some children’s asthma is more severe; they may have other health problems; triggers like cold weather and respiratory infections may not be easily avoided; parents may not know their child has asthma until after the first ER trip. But the visits often are linked to a family’s income, education and neighborhood location, according to national research.
Some Utah areas with high hospitalization rates have higher concentrations of poorer and less educated families. Low education levels are tied to higher levels of smoking — and secondhand smoke worsens asthma symptoms in children.
Children in low-income families are more likely to live in substandard housing, which is tied to exposure to triggers such as cockroaches and mold. Also, they are less likely to have access to primary care or asthma medications.
Neighborhood placement matters, too: Research shows asthma is worse for children who live or attend school near freeways because it exposes them to higher doses of pollution than surrounding areas receive.
“It might be very difficult for someone in a lower [socioeconomic status] to miss work to take a child to a provider, even if they have one,” said Bryan Stone, a doctor at Primary Children’s Medical Center after seeing the Tribune data, explaining generally why income matters to health.
“Just the placement of I-15 on the west side of the valley, the lack of mass transit and more automobiles — there are all sorts of things that are known risk factors for asthma hospitalizations that can play into this,” he continued.
While it’s not clear that those factors are the cause of Utah’s disparities, some public health officials are starting to tackle smoking, home environments and freeways to help children most at risk.
This story was reported with the assistance of interpreter Maritza McKee.
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About the project
This article was conceived and produced as a project for The California Endowment Health Journalism Fellowships, a program of the University of Southern California’s Annenberg School for Communication & Journalism.