BACKGROUND
Environmental exposures and social determinants likely influence specific childhood asthma phenotypes.
OBJECTIVE
We hypothesized that the Child Opportunity Index (COI) at birth, measuring multiple neighborhood opportunities, influences incidence rates (IRs) for asthma with recurrent exacerbations (ARE).
METHODS
We tested for COI associations with ARE incidence rates in 15,877 children born between 1990-2018 in the Environmental Influences on Child Health Outcomes (ECHO) program. Parent-reported race and ethnicity and other demographics were assessed as effect modifiers.
RESULTS
The IR of ARE for children born in very low COI neighborhoods was higher (IR=10.98; 95% Confidence Intervals (CI) 9.71, 12.25) than for other COI categories. Rates for Non-Hispanic Black children (NHB) were significantly higher than Non-Hispanic White (NHW) children in every COI category. The ARE IRs for children born in very low COI neighborhoods were several-fold higher for NHB and Hispanic Black (HB) children (IR=15.30; 95% CI 13.10, 17.49; IR=18.48; 95% CI 8.80, 28.15 respectively) when compared to White children. Adjusting for individual-level characteristics, children born in very low COI neighborhoods demonstrated an ARE incidence rate ratio (IRR) of 1.26 (95% CI 0.99,1.59) with a higher incidence of cases among children ages 2-4 years and with a parental history of asthma.
CONCLUSIONS
Rates of ARE were higher among children born in under-resourced communities and this relationship is strongest for young minoritized children with a parental history of asthma. Higher rates for NHB even in the highest COI categories suggest that risk associated with race persists regardless of social disadvantage.