A lower incidence of childhood asthma has been found among those residing in neighborhoods with high levels of opportunity in early life, researchers reported in JAMA Pediatrics.

Researchers explored associations between childhood asthma incidences in various neighborhoods and the physical and social characteristics of those neighborhoods, using data from the Environmental Influences on Child Health Outcomes (ECHO) program from January 1, 1995, to August 31, 2022. Participants in the cohort study were children with at least 1 high-quality geocoded residential address from birth and a parent or caregiver report of a physician’s diagnosis of asthma.

Using the Child Opportunity Index (COI) and Social Vulnerability Index (SVI), census tracts were classified with respect to opportunity and vulnerability as very low (<20th percentile), low (20th to <40th percentile), moderate (40th to <60th percentile), high (60th to <80th percentile), or very high (≥80th percentile).

Given the long-term association of childhood asthma with adult health, additional research is warranted to investigate whether strategies that alter specific neighborhood components would be effective in preventing childhood asthma.

Participating children’s parents or caregivers reported the child’s asthma history during infancy, childhood, and adolescence, as well as the child’s age at asthma diagnosis. The children were followed up to the date of asthma diagnosis, date of last visit or loss to follow-up, or age 20 years.

The analysis included 46 ECHO cohorts with 10,516 children. The children’s median age at follow-up was 9.1 years (interquartile range [IQR], 7.0-11.6 years), 47.8% were female, and 65.3% were White. Of the cohort, 20.6% of children lived in neighborhoods with very high COI and very low SVI. The incidence rate for asthma was 23.3 cases per 1000 child-years, and the median age at asthma diagnosis was 6.6 years (IQR, 4.1-9.9 years).

Areas with higher opportunities had lower crude asthma incidence rates. Moderate (adjusted incidence rate ratio [IRR], 0.87; 95% CI, 0.75-1.00), high (adjusted IRR, 0.87; 95% CI, 0.75-1.00), or very high (adjusted IRR, 0.83; 95% CI, 0.71-0.98) COI at birth vs very low COI was associated with lower asthma incidence after adjustment for sociodemographic characteristics, parental history of asthma, and parity.

Crude asthma incidence rates also were reduced in areas with lower social vulnerability. Lower vs very high SVI at birth, infancy, and early childhood was not significantly associated with asthma incidence after adjustment for sociodemographic characteristics, parental history of asthma, and parity. However, 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.

The association of a very high COI for each life stage with lower asthma incidence appeared related to the health and environmental domain and the social and economic domain, but not the education domain, the researchers noted. No significant associations were found for each SVI domain and asthma incidence, and no evidence was observed of modification of associations by child sex, race/ethnicity, or rural residence.

Study limitations include the reliance on parent or caregiver report of physician-diagnosed asthma and the use of residential census tracts as markers of exposure. Also, both the COI and SVI indices include many correlated individual indicators, and the study did not consider how residential mobility from birth to early childhood may have affected changes in COI or SVI over time.

“Given the long-term association of childhood asthma with adult health, additional research is warranted to investigate whether strategies that alter specific neighborhood components would be effective in preventing childhood asthma,” stated the researchers.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

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