Neighborhood Opportunity and Vulnerability and Incident Asthma Among Children
Authors: Aris Izzuddin M. , Perng Wei , Dabelea Dana , Padula Amy M. , Alshawabkeh Akram , Vélez-Vega Carmen M. , Aschner Judy L. , Camargo Carlos A. , Sussman Tamara J. , Dunlop Anne L. , Elliott Amy J. , Ferrara Assiamira , Joseph Christine L. M. , Singh Anne Marie , Breton Carrie V. , Hartert Tina , Cacho Ferdinand , Karagas Margaret R. , Lester Barry M. , Kelly Nichole R. , Ganiban Jody M. , Chu Su H. , O’Connor Thomas G. , Fry Rebecca C. , Norman Gwendolyn , Trasande Leonardo , Restrepo Bibiana , Gold Diane R. , James Peter , Oken Emily ,   Environmental Influences on Child Health Outcomes, Baluch Samia , Shields Timothy , Merhar Stephanie , Ren Clement , Pryhuber Gloria , Moore Paul , Wadhawan Rajan , Wagner Carol , Keller John R , Reynolds Amy , Keller Roberta , Hudak Mark , Duncan Adam , Walshburn Ronald , Teitelbaum Susan L , Stroustrup Annemarie , Lampland Andrea , Mayock Dennis , Mansbach Jonathan , Spergel Jonathan , Stevenson Michelle , Bauer Cindy , Gern James , Seroogy Christine , Bendixsen Casper , Hertz-Picciotto Irva , Karr Catherine , Mason Alex , Weiss Scott , O’Connor George , Zeiger Robert , Bacharier Leonard , Carter Brian , Marsit Carmen , Pastyrnak Steven , Neal Charles , Smith Lynne , Helderman Jennifer , Tepper Robert , Newschaffer Craig , Volk Heather , Schmidt Rebecca , Kerver Jean , Barone Charles , McKane Patricia , Paneth Nigel , Elliott Michael , Schantz Susan , Porucznik Christina , Silver Robert , Conradt Elisabeth , Bosquet-Enlow Michelle , Huddleston Kathi , Bush Nicki , Nguyen Ruby , Barrett Emily , Hipwell Alison , Keenan Kate , Duarte Christiane , Canino Glorisa , Dager Stephen , Schultz Robert , Piven Joseph , Simhan Hyagriv , Gilliland Frank , Farzan Shoreh , Bastain Tracy 
Published: August 2023

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 (&amp;lt;20th percentile), low (20th to &amp;lt;40th percentile), moderate (40th to &amp;lt;60th percentile), high (60th to &amp;lt;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.