Childhood Asthma Incidence, Early and Persistent Wheeze, and Neighborhood Socioeconomic Factors in the ECHO/CREW Consortium
Antonella Zanobetti, Patrick Ryan, Brent A. Coull, Cole Brokamp, Soma Datta, Jeffrey C. Blossom, Nathan Lothrop, Rachel L. Miller, Paloma I. Beamer, Cynthia M. Visness, Howard Andrews, Leonard B. Bacharier, Tina V. Hartert, Christine Cole Johnson, Dennis R. Ownby, Gurjit K. Khurana Hershey, Christine L.M. Joseph, Yiqiang Song, Eneida A. Mendonça, Daniel J. Jackson, Heike Luttmann‐Gibson, Edward M. Zoratti, Anne L. Wright, Fernando D. Martínez, Christine M. Seroogy, James E. Gern, Diane R. Gold, Adam Nunez, Adnan Čustović, Agustin Calatroni, Albert M. Levin, Alex Binder, Alexandra R. Sitarik, Amanda Cyrus, Amber Spangenberg, Amelia Jones, Amy Dresen, Ana Manuelian, Andrea E. Cassidy‐Bushrow, Andrew Jerrison, Angela Freie, Anne Marie Singh, Anthony Wahlman, Audrey Urquhart, Aviva Lee-Parritz, Ben Green, Brenda Patterson, Brent Davidson, Brent F. Olson, Brian Hallmark, Caitlin Suddueth, Camille Johnson, Carin Lamm, Carole Ober, Carolina Jordan, Casper G. Bendixsen, Cathey Strauchman Boyer, Charles Barone, Charlotte Nicholas, Chris Lim, Chris M Reyes, Chris Sutton, C.J. Tisler, Christopher L. Wolfe, Christopher G. McKennan, Conner Fleurat, Daniel Nicolae, David J. Kemp, David O. Morgan, David Spies, Dean Billheimer, Deanna Cole, Deborah Chasman, Debra A. Stern, Deliang Tang, Dena Scott, Douglas DaSilva, Edlira Gjerasi, Edward Peterson, Elizabeth A. Anderson, Elizabeth Armagost, Elizabeth C. Matsui, Elizabeth Tesson, Elsie Parmar, Emily Bull, Eric Schauberger, Erin Donnerbauer, Frank R. Witter, Frederica P. Perera, Ganesa Wegienka, George O'connor, Geraldine Birg, Gina Simpson, Gina Crisafi, Gina M. Stouffer, Gordon R. Bloomberg, Grace K. LeMasters, Hae Jin Kim, Heather Floerke, Heidi S. Erickson
Abstract
Importance: In the United States, Black and Hispanic children have higher rates of asthma and asthma-related morbidity compared with White children and disproportionately reside in communities with economic deprivation. Objective: To determine the extent to which neighborhood-level socioeconomic indicators explain racial and ethnic disparities in childhood wheezing and asthma. Design, Setting, and Participants: The study population comprised children in birth cohorts located throughout the United States that are part of the Children's Respiratory and Environmental Workgroup consortium. Cox proportional hazard models were used to estimate hazard ratios (HRs) of asthma incidence, and logistic regression was used to estimate odds ratios of early and persistent wheeze prevalence accounting for mother's education, parental asthma, smoking during pregnancy, child's race and ethnicity, sex, and region and decade of birth. Exposures: Neighborhood-level socioeconomic indicators defined by US census tracts calculated as z scores for multiple tract-level variables relative to the US average linked to participants' birth record address and decade of birth. The parent or caregiver reported the child's race and ethnicity. Main Outcomes and Measures: Prevalence of early and persistent childhood wheeze and asthma incidence. Results: Of 5809 children, 46% reported wheezing before age 2 years, and 26% reported persistent wheeze through age 11 years. Asthma prevalence by age 11 years varied by cohort, with an overall median prevalence of 25%. Black children (HR, 1.47; 95% CI, 1.26-1.73) and Hispanic children (HR, 1.29; 95% CI, 1.09-1.53) were at significantly increased risk for asthma incidence compared with White children, with onset occurring earlier in childhood. Children born in tracts with a greater proportion of low-income households, population density, and poverty had increased asthma incidence. Results for early and persistent wheeze were similar. In effect modification analysis, census variables did not significantly modify the association between race and ethnicity and risk for asthma incidence; Black and Hispanic children remained at higher risk for asthma compared with White children across census tracts socioeconomic levels. Conclusions and Relevance: Adjusting for individual-level characteristics, we observed neighborhood socioeconomic disparities in childhood wheeze and asthma. Black and Hispanic children had more asthma in neighborhoods of all income levels. Neighborhood- and individual-level characteristics and their root causes should be considered as sources of respiratory health inequities.