Black and Hispanic children were found to have greater incidence of asthma in neighborhoods of all income levels, according to a study published in JAMA Pediatrics.

Children from densely populated or poorer neighborhoods were also found to be more likely to develop asthma and wheezing.

“Understanding the relationships between race and ethnicity and the physical and social environments of neighborhoods that contribute to the persistence of early childhood wheeze and onset of asthma is essential to guiding research, policies, and interventions to reduce asthma disparities,” wrote the authors.¹

A longitudinal study was conducted to determine the associations of neighborhood-level socioeconomic status measures with childhood wheezing and asthma incidence.

Researchers also examined whether neighborhood-level socioeconomic status modifies the association between race and ethnicity and childhood wheezing and asthma.

The study population comprised 10 of 12 cohorts participating in the Children’s Respiratory and Environmental Workgroup consortium, including children born over a span of 4 decades from diverse areas across the United States. Each child’s home address was matched to US Census tract data corresponding with their birth year.

The resulting analysis revealed large disparities in census socioeconomic indicators by race and ethnicity.

Black and Hispanic children were found to be more likely to reside in neighborhoods with greater population densities and higher rates of poverty.

In census tracts with high proportions of the population below the poverty level, 49% of the children were Black, 35% were Hispanic, and only 13% were White.

In tracts with low proportions of the population below the poverty level, a majority (83%) of children were white.

Children born in census tracts with higher levels of poverty and lower household income were identified at an elevated risk for childhood wheezing and developing asthma.

Of 5809 children studied, 46% reported wheezing before age 2 and 26% reported persistent wheeze through age 11.

Though asthma prevalence by age 11 varied by cohort, 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.

Black and Hispanic children also experienced earlier onset of asthma incidence.

Additionally, race and ethnicity were found to persist as a risk factor after adjusting for neighborhood income. The authors suggest that this indicates the presence of structural inequities that increase wheeze and asthma risk among Black and Hispanic children, regardless of neighborhood affluence.

However, the study did not find that neighborhood factors significantly modified estimates of risk for asthma among Black or Hispanic children, though the risk for asthma incidence remained higher for Black and Hispanic children across all neighborhoods.

Stress, racial bias, and differential access to health care and other resources may persist among Black families in affluent neighborhoods, contributing to asthma risk, note the authors.

These findings add to previous studies demonstrating that both race and ethnicity and neighborhood factors are associated with the onset of disease.

The authors suggest that future studies should be conducted considering neighborhood and individual level characteristics that individually or in combination explain elevated rates of asthma incidence to help guide intervention and policies to improve health among the disproportionately affected.

“As with every other health outcome for which racial disparities have been documented, racial disparities in asthma risk reflect the reality that race is a social construct that serves as a proxy for complex interactions between genetic ancestry and environmental and social factors related to structural and interpersonal racism,” wrote the authors of an accompanying editorial.² “Mitigating racial disparities in asthma risk will require structural solutions and policy changes.”

Reference

1. Antonella Z, Patrick HR, Brent C, et al. childhood asthma incidence, early and persistent wheeze, and neighborhood socioeconomic factors in the ECHO/CREW consortium. JAMA Pediatr. Published online May 23, 2022. doi:10.1001/jamapediatrics.2022.1446

2. Daniel TM, Tyra CBS, Diana MW. Childhood asthma disparities—race, place, or not keeping pace? JAMA Pediatr. Published online May 23, 2022. doi:10.1001/jamapediatrics.2022.1457