The Role of Neighborhood Air Pollution in Disparate Racial and Ethnic Asthma Acute Care Use

The Interplay of Pollution, Child Opportunity, and High Health Care Utilization in Children With Asthma in San Diego County

OBJECTIVES

This study aims to (1) compare air pollution and child opportunity between neighborhoods with and without high health care utilization (HHU) for asthma, and (2) compare health care utilization frequency by race, ethnicity, primary language, and insurance type at the patient level.

METHODS

This retrospective cohort study examined children with asthma within the Rady Children's Health System (2015-2020) who met HHU criteria [≥2 emergency department (ED) visits in 6 months or ≥2 hospitalizations in 12 mo]. Patient addresses were geocoded to census tracts, and ArcGIS was used to map CalEnviroScore 4.0 and the Child Opportunity Index. Descriptive statistics assessed health care utilization differences based on patient demographics.

RESULTS

This study included 1070 individuals. The median HHU asthma rate was 1.7 per 1000 children (interquartile range: 0.9 to 3.1) across 408 census tracts. Pollution burden was significantly higher in tracts with HHU asthma cases than those without ( P = 0.002). Census tracts with HHU asthma cases had lower Child Opportunity Index scores compared with those without ( P < 0.001). Black patients had more ED visits than white patients ( P = 0.002). Hispanic patients had more inpatient hospitalizations than non-Hispanics ( P = 0.043). Medicaid/Medi-Cal patients had more ED and inpatient encounters than those with commercial insurance ( P = 0.001).

CONCLUSIONS

We identified disparities in pollution and child opportunity among pediatric asthma patients with HHU. These differences are linked to race, ethnicity, and insurance type. These findings can guide efforts to improve child health equity.

Genetic modifiers of asthma response to air pollution in children: An African ancestry GWAS and PM2.5 polygenic risk score study

RATIONALE

Ambient air pollution (AAP) is linked to asthma outcomes, but predicting individual risk remains challenging. Understanding genetic contributors to AAP sensitivity may help overcome this gap.

OBJECTIVES

To determine if single nucleotide polymorphisms (SNPs) are associated with AAP sensitivity in children with asthma.

METHODS

We complete a GWAS in pediatric patients with asthma frequently exposed to AAP, comparing patients with exacerbations following spikes in AAP to patients without this temporal association and calculate a polygenic risk score (PRS) for PM2.5. This PRS was validated using internal data and data from the All of Us cohort.

MEASUREMENTS AND RESULTS

We included 6023 patients in the GWAS, restricted to the African ancestry cohort due to the association between AAP exposure and race. Three loci reached genome-wide significance, including rs111970601, associated with CO sensitivity (odds ratio [OR] 6.58; P = 1.63 × 10-8) and rs9836522 with PM2.5 sensitivity (OR 0.75; P = 3,87 × 10-9), both externally validated. PRS z-scores were associated with increased asthma exacerbations in patients frequently exposed to poor air quality (β = 0.15; P = 2.67 × 10⁻⁵). Spirometry data from 4138 patients showed that having a high PRS was associated with lower FVC z-scores in patients frequently exposed to AAP (β = -0.44; P = 0.035). External validation confirmed a significant interaction between high PRS and frequent AAP exposure (β = 0.30; P = 0.012) CONCLUSIONS: We associate specific SNPs with AAP-related asthma exacerbations and introduce a PM2.5 sensitivity PRS, paving the way for future research aimed at protecting genetically predisposed patients.

Strategies to Implement a Community-Based, Longitudinal Cohort Study: The Whole Communities-Whole Health Case Study

This paper discusses the implementation of the Whole Communities-Whole Health (WCWH) initiative, which is a community-based, longitudinal cohort study. WCWH seeks to better understand the impact of location on family health and child development while also providing support for families participating in the study. Implementing a longitudinal study that is both comprehensive in the data it is collecting and inclusive in the population it is representing is what makes WCWH extremely challenging. This paper highlights the learning process the initiative has gone through to identify effective strategies for implementing this type of research study and work toward building a new model for community-engaged research. Through iterative testing following the Plan-Do-Study-Act model, three main strategies for implementation were identified. These strategies are (1) creating a data collection schedule that balances participant burden and maintains temporality across data types; (2) facilitating multiple opportunities for qualitative and quantitative input from faculty, families, and nonparticipant community members; and (3) establishing an open-door policy for data analysis and interpretation. This paper serves as a guide and provides resources for other researchers wanting to implement a multidisciplinary and community-based cohort study.

Neighborhood-level variability in asthma-related emergency department visits in Central Texas

BACKGROUND

The extent to which incidence rates of asthma-related emergency department (ED) visits vary from neighborhood to neighborhood and predictors of neighborhood-level asthma ED visit burden are not well understood.

OBJECTIVE

We aimed to describe the census tract-level spatial distribution of asthma-related ED visits in Central Texas and identify neighborhood-level characteristics that explain variability in neighborhood-level asthma ED visit rates.

METHODS

Conditional autoregressive models were used to examine the spatial distribution of asthma-related ED visit incidence rates across census tracts in Travis County, Texas, and assess the contribution of census tract characteristics to their distribution.

RESULTS

There were distinct patterns in ED visit incidence rates at the census tract scale. These patterns were largely unexplained by socioeconomic or selected built environment neighborhood characteristics. However, racial and ethnic composition explained 33% of the variability of ED visit incidence rates across census tracts. The census tract predictors of ED visit incidence rates differed by racial and ethnic group.

CONCLUSIONS

Variability in asthma ED visit incidence rates are apparent at smaller spatial scales. Most of the variability in census tract-level asthma ED visit rates in Central Texas is not explained by racial and ethnic composition or other neighborhood characteristics.