Understanding individual- and neighborhood-level disparities in pediatric asthma

Published: August 12, 2022

Previous studies have evaluated racial disparities in asthma outcomes but with limited information from individual and neighborhood-level exposures. This study sought to examine differences in the rate of emergency department (ED) visits among African American (AA) and European American (EA) children, considering a range of potentially impactful underlying social, economic, and environmental exposures across both individual and neighborhood levels.

This study published in The Journal of Allergy and Clinical Immunology (JACI) reviewed data from children who visited the ED at Cincinnati Children’s for asthma from 2009 to 2018. We assessed 11 social, economic, and environmental variables to measure the relationships between patient race, mediators, and number of ED visits.

A total of 31,114 children (46.1% AA, 53.9% EA) had 186,779 asthma-related ED visits during the study period. AA children had more visits per year than EA children (2.23 vs 2.15; p<0.001). Neighborhood socioeconomic deprivation was associated with an increased rate of ED visits in AA, but not EA children. Area-level PM2.5 (an environmental pollutant), pollen, and outdoor mold were associated with an increased rate of ED visits for both AA and EA children (all p<0.001). The associations between race and number of ED visits were mediated by insurance (p<0.001) and neighborhood socioeconomic deprivation (p<0.001), PM2.5 (p<0.001), and mold (p<0.001).

Our findings support the notion that racial disparities in asthma-related ED visits are driven mainly by neighborhood socioeconomic deprivation (33%), Medicaid insurance (19%), outdoor mold (2%) and environmental pollutant PM2.5 (1%) at both individual and neighborhood levels (all p<0.001). We found that racial disparities in the number of ED visits for asthma care reflect the outcomes of long entrenched systemic racism. AA children were more likely to live in socioeconomically deprived areas, live in areas with less green space availability, and visit the ED more frequently than EA children. This assessment of multi-level risk factors that drive racial disparities in asthma outcomes suggests that asthma burden among AA children can be reduced through non-medical improvements in lived environments.

The Journal of Allergy and Clinical Immunology is an official scientific journal of the AAAAI and is the most-cited journal in the field of allergy and clinical immunology.

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