Examining Socio-environmental Factors in Childhood Asthma
Asthma exacerbation in children continues to be the leading cause of pediatric emergency department visits and hospitalizations. It also disproportionately affects Latinx and Black children, compared to non-Latinx White children, living in New York City. Socio-environmental and housing factors – both on the individual and community levels – increase the probability of childhood asthma and asthma exacerbation and are prime contributors to health disparities, and yet these factors are often investigated separately.
To better understand the multiple contributors to disparities in childhood asthma, Stephanie Lovinsky-Desir, MD, Chief of Pediatric Pulmonology at NewYork-Presbyterian Morgan Stanley Children’s Hospital and Assistant Professor of Pediatrics at Columbia, collaborated on a cross-sectional study with the City University of New York Institute for State and Local Governance, Department of Health and Mental Hygiene, and City University of New York School of Public Health. Their investigation sought to identify the primary patterns of social and environmental factors experienced by children in New York City and assess whether certain patterns are more likely to provoke asthma exacerbations.
The researchers compiled data from the New York City Department of Health’s KIDS 2017 Survey and the U.S. Census’s American Community Survey on individual and neighborhood level socioeconomic and environmental factors, including education, race/ethnicity, income disparities, gentrification, housing characteristics, built environment, and structural racism.
The NYC KIDS survey included data from telephone interviews with 7,507 randomly selected households with one or more children up to the age of 13. Those responding were parents – generally mothers – guardians, or other family members who were well informed about a child’s health, doctor visits, as well as family and neighborhood characteristics. The study analysis focused on children 6 years and older due to the possibility of an inaccurate clinical diagnosis of asthma in children younger than 6.
Asthma exacerbation was determined with the survey question: “During the past 12 months, has your child had an episode of asthma or an asthma attack?” Lifetime asthma was determined with the question: “Has a doctor or health professional ever told you or another caregiver that your child has asthma?” The prevalence of asthma exacerbation was the primary outcome of this analysis.
“Neighborhoods with a high proportion of renters, dense apartment buildings, and old building structures are vital areas that could benefit from the prioritization of housing interventions to improve asthma outcomes in families.” — Study Authors
Study findings, which were published in the December 2021 issue of the Journal of Urban Health, showed:
- 1,959 respondents had children between the ages of 6 and 13 years (average age 9.2 years) with an even distribution of male and female.
- Racial/ethnic distribution included 41.2 percent Latinx, 21.2 percent non-Latinx Black, 21.7 percent non-Latinx White, 11.3 percent non-Latinx Asian/Pacific Islander, and 4.5 percent other backgrounds.
- Parents reported 16.5 percent of children had received a diagnosis of asthma by a health professional at some point in their life.
- More than half of these children were Latinx (57.4 percent).
- A majority came from low-income households at < 200 percent of the federal poverty level (73.6 percent).
- 39.5 percent of children had experienced an asthma exacerbation in the previous 12 months; most of these children were Latinx (50.8 percent) or non-Latinx Black (30.5 percent).
The analysis showed that three clusters produced patterns in housing and neighborhood-level characteristics. The top three features were: percent of renters within a zip code, percent of buildings built before 1940 in the zip code, and percent of dense buildings (20 or more units) in the zip code.
Dr. Lovinsky-Desir and her colleagues determined that housing and built environment characteristics, such as density and age of buildings, were the primary features differentiating the socio-environmental patterns seen in New York City, noting that:
- The “high-density renters” cluster, characterized by children living in zip codes with a high proportion of renters and dense buildings, had the highest rate of asthma exacerbation among children with a lifetime diagnosis of asthma, as well as the most roach and mice sightings.
- The “newer, less dense buildings” cluster with the lowest proportion of renters, dense buildings, and older buildings, demonstrated the lowest rate of asthma exacerbation and the least roach and mice sightings.
- The “older, less dense buildings” cluster also had high proportions of renters but fewer dense buildings and more old buildings. The rates of asthma exacerbation and proportion of roach and mice sightings were similar in the older, less dense buildings cluster and the high-density renters cluster and differed from the newer, less dense buildings cluster. These findings indicate that neighborhoods with older housing of varying density may have greater indoor environmental triggers, such as rodents, and therefore confer a greater risk of asthma exacerbations among children living in those circumstances.
The findings of this study highlight the importance of neighborhood-level environmental influences that likely contribute to the individual-level residential factors that cause acute asthma exacerbations. This information can assist public health practitioners in targeting interventions at a community level to reduce asthma exacerbation among children living in New York City.
Multi-Level Socio-environmental Contributors to Childhood Asthma in New York City: a Cluster Analysis. Khan S, Bajwa S, Brahmbhatt D, Lovinsky-Desir S, Sheffield PE, Stingone JA, Li S. Journal of Urban Health. 2021 Dec;98(6):700-710.
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