Neighborhood Opportunity and Vulnerability and Incident Childhood Asthma (2024)

• ¹Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts

• ²Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora

• ³Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora

• ⁴Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora

• ⁵Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco

• ⁶Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts

• ⁷University of Puerto Rico (UPR) Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, Puerto Rico

• ⁸Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey

• ⁹Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York

• ¹⁰Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

• ¹¹Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts

• ¹²Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston

• ¹³Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York

• ¹⁴Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia

• ¹⁵Avera Research Institute, Sioux Falls, South Dakota

• ¹⁶Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls

• ¹⁷Division of Research, Kaiser Permanente Northern California, Oakland

• ¹⁸Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan

• ¹⁹Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin–Madison

• ²⁰Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles

• ²¹Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee

• ²²Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire

• ²³Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, Rhode Island

• ²⁴Department of Counseling Psychology and Human Services, Prevention Science Institute, University of Oregon, Eugene

• ²⁵Department of Psychological and Brain Sciences, George Washington University, Washington, DC

• ²⁶Department of Psychiatry, University of Rochester, Rochester, New York

• ²⁷Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill

• ²⁸Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Wayne State University, Detroit, Michigan

• ²⁹Department of Pediatrics, Grossman School of Medicine, New York University, New York

• ³⁰Department of Pediatrics, School of Medicine, University of California, Davis, Sacramento

• ³¹Department of Medicine, Harvard Medical School, Boston, Massachusetts

• ³²Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

Key Points

Question Is there an association of neighborhood-level measures of opportunity and social vulnerability in early life with childhood asthma incidence?

Findings In this nationwide cohort study including 10 516 children, residence in neighborhoods with high or very high opportunity in early life, especially those with high health and environmental or social and economic opportunity, was associated with lower subsequent asthma incidence compared with residence in very low–opportunity neighborhoods.

Meaning The findings suggest the need for future studies examining whether investing in health and environmental or social and economic resources in early life would promote health equity in pediatric asthma.

Background The extent to which physical and social attributes of neighborhoods play a role in childhood asthma remains understudied.

Objective To examine associations of neighborhood-level opportunity and social vulnerability measures with childhood asthma incidence.

Design, Setting, and Participants This cohort study used data from children in 46 cohorts participating in the Environmental Influences on Child Health Outcomes (ECHO) Program between January 1, 1995, and August 31, 2022. Participant inclusion required at least 1 geocoded residential address from birth and parent or caregiver report of a physician’s diagnosis of asthma. Participants were followed up to the date of asthma diagnosis, date of last visit or loss to follow-up, or age 20 years.

Exposures Census tract–level Child Opportunity Index (COI) and Social Vulnerability Index (SVI) at birth, infancy, or early childhood, grouped into very low (<20th percentile), low (20th to <40th percentile), moderate (40th to <60th percentile), high (60th to <80th percentile), or very high (≥80th percentile) COI or SVI.

Main Outcomes and Measures The main outcome was parent or caregiver report of a physician’s diagnosis of childhood asthma (yes or no). Poisson regression models estimated asthma incidence rate ratios (IRRs) associated with COI and SVI scores at each life stage.

Results The study included 10 516 children (median age at follow-up, 9.1 years [IQR, 7.0-11.6 years]; 52.2% male), of whom 20.6% lived in neighborhoods with very high COI and very low SVI. The overall asthma incidence rate was 23.3 cases per 1000 child-years (median age at asthma diagnosis, 6.6 years [IQR, 4.1-9.9 years]). High and very high (vs very low) COI at birth, infancy, or early childhood were associated with lower subsequent asthma incidence independent of sociodemographic characteristics, parental asthma history, and parity. For example, compared with very low COI, the adjusted IRR for asthma was 0.87 (95% CI, 0.75-1.00) for high COI at birth and 0.83 (95% CI, 0.71-0.98) for very high COI at birth. These associations appeared to be attributable to the health and environmental and the social and economic domains of the COI. The SVI during early life was not significantly associated with asthma incidence. For example, compared with a very high SVI, the adjusted IRR for asthma was 0.88 (95% CI, 0.75-1.02) for low SVI at birth and 0.89 (95% CI, 0.76-1.03) for very low SVI at birth.

Conclusions In this cohort study, high and very high neighborhood opportunity during early life compared with very low neighborhood opportunity were associated with lower childhood asthma incidence. These findings suggest the need for future studies examining whether investing in health and environmental or social and economic resources in early life would promote health equity in pediatric asthma.

Health Disparities Pediatrics Health Inequities Equity, Diversity, and Inclusion Asthma Pulmonary Medicine

Citation

Aris IM, Perng W, Dabelea D, et al. Neighborhood Opportunity and Vulnerability and Incident Asthma Among Children. JAMA Pediatr. 2023;177(10):1055–1064. doi:10.1001/jamapediatrics.2023.3133

Manage citations:

© 2024