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High burden of atopy in immigrant families in substandard apartments in Sweden - on the contribution of bad housing to poor health in vulnerable populations

Journal article
Authors J. C. Richter
Kristina Jakobsson
T. Taj
A. Oudin
Published in World Allergy Organization Journal
Volume 11
ISSN 1939-4551
Publication year 2018
Published at Institute of Medicine, Department of Public Health and Community Medicine, Section of Occupational and environmental medicine
Language en
Keywords day-care attendance, asthma symptoms, risk-factors, respiratory, symptoms, allergic symptoms, childhood asthma, moisture damage, parental, atopy, birth-cohort, children, Allergy, Immunology
Subject categories Allergology


Background: Atopic disorders are a global concern. Studies in migrant populations can illuminate the interplay of genetic and environmental factors. Exposures related to bad housing (indoor dampness, mould growth, crowding etc.) are likely to play a role in how socioeconomic inequalities can turn into health disparities for disadvantaged populations. The sizable immigrant population living in very poor-quality housing in Malmo, Sweden, became the focus of a cross-sectional study. Objective: To describe atopic disorders and sensitizations in a population living in substandard housing in Malmo, Sweden, with an emphasis on their relation to harmful exposures from the built environment. Methods: Families were recruited via identification of any children with symptomatic airway afflictions from health care records, and also asymptomatic children from school lists. Interviewer-led health questionnaire data and data from self-reports about living conditions were obtained together with data from home inspections carried out by health communicators. Families underwent skin prick tests (SPT) against common aeroallergens. Results: As could be expected from background demographic information, it turned out that we effectively studied an immigrant population inhabiting very precarious housing outside the center of Malmo. A total of 359 children from 130 families (total 650 participants) were included. Overall the prevalence of potentially harmful environmental exposures was high (signs of moisture or mould in more than 50% of apartments, indoor smoking in 37% of households). Atopic disorders were common among both adults and children. SPTs showed a spectrum of sensitizations consistent with unselected populations in Sweden. Paternal sensitization in the SPT was associated with higher risk of sensitization for offspring than maternal sensitization. Few statistically significant associations of atopic sensitization with studied environmental exposures were detected (for example objective signs of dampness /mould in bathrooms). There were marked discrepancies between asthma diagnoses obtained from the health records and parental reports of such diagnoses and treatment for their children. Conclusions: The atopic burden in this selected immigrant population was high, and results point to unmet medical needs. Health care systems caring for such populations need to be aware of their specific health needs; comprehensive asthma and allergy care should include consideration of harmful environmental exposures, adhering to the precautionary principle.

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