Understanding racial disparities in childhood asthma using individual- and neighborhood-level risk factors

Esteban Correa-Agudelo; Lili Ding; Andrew F Beck; Cole Brokamp; Mekibib Altaye; Robert S Kahn; Tesfaye B Mersha

doi:10.1016/j.jaci.2022.07.024

Understanding racial disparities in childhood asthma using individual- and neighborhood-level risk factors

J Allergy Clin Immunol. 2022 Dec;150(6):1427-1436.e5. doi: 10.1016/j.jaci.2022.07.024. Epub 2022 Aug 12.

Authors

Esteban Correa-Agudelo¹, Lili Ding², Andrew F Beck³, Cole Brokamp², Mekibib Altaye², Robert S Kahn⁴, Tesfaye B Mersha⁵

Affiliations

¹ Divisions of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
² Divisions of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
³ Divisions of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; Divisions of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
⁴ Divisions of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
⁵ Divisions of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio. Electronic address: tesfaye.mersha@cchmc.org.

Abstract

Background: Racial disparities in childhood asthma outcomes result from a complex interplay of individual- and neighborhood-level factors.

Objectives: We sought to examine racial disparities in asthma-related emergency department (ED) visits between African American (AA) and European American (EA) children.

Methods: This is a retrospective study of patients younger than 18 years who visited the ED at Cincinnati Children's for asthma from 2009 to 2018. The outcome was number of ED visits during a year. We assessed 11 social, economic, and environmental variables. Mediation and mixed-effects analyses were used to assess relationships between race, mediators, and number of ED visits.

Results: A total of 31,114 children (46.1% AA, 53.9% EA) had 186,779 asthma-related ED visits. AA children had more visits per year than EA children (2.23 vs 2.15; P < .001). Medicaid insurance was associated with a 7% increase in rate of ED visits compared with commercial insurance (1.07; 95% CI, 1.03-1.1). Neighborhood socioeconomic deprivation was associated with an increased rate of ED visits in AA but not in EA children. Area-level particulate matter with diameter less than 2.5 μm, pollen, and outdoor mold were associated with an increased rate of ED visits for both AA and EA children (all P < .001). Associations between race and number of ED visits were mediated by insurance, area-level deprivation, particulate matter with diameter less than 2.5 μm, and outdoor mold (all P < .001), altogether accounting for 55% of the effect of race on ED visits. Race was not associated with number of ED visits (P = .796) after accounting for mediators.

Conclusions: Racial disparities in asthma-related ED visits are mediated by social, economic, and environmental factors, which may be amenable to interventions aimed at improving outcomes and eliminating inequities.

Keywords: Asthma; electronic health records; environmental exposure; mediation analysis; mixed-effects analysis; racial disparities.

MeSH terms

Child
Humans
Retrospective Studies*
Risk Factors

Abstract

MeSH terms

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