Childhood Asthma Incidence, Early and Persistent Wheeze, and Neighborhood Socioeconomic Factors in the ECHO/CREW Consortium

To examine the effect of neighborhood-level socioeconomic factors on childhood wheeze and asthma.

There were 5809 children enrolled in the Children’s Respiratory and Environmental Workgroup birth cohort.

Census information of Children’s Respiratory and Environmental Workgroup participants were obtained using the Decentralized Geomarker Assessment for Multisite Studies approach. Asthma incidence was obtained from caregiver report of physician diagnosis. Early wheeze and persistent wheeze were defined per caregiver reported information (early: wheeze at 1–2 years, persistent: up to 4 years with at least 1 episode between 5–11 years). Hazard ratios of asthma incidence and odds ratios of wheeze prevalence were determined for factors including maternal education, maternal smoking history during pregnancy, and parental history of asthma.

Overall prevalence of early and persistent wheeze were 46% and 26%, respectively. Asthma prevalence by 11 years of age had a median prevalence of 25%. Factors associated with increased hazard ratio (HR) of asthma included race (HR 1.47; 95% confidence interval, 1.26–1.73 for Black children and HR 1.29; 95% confidence interval, 1.09–1.53 for Hispanic children), low income-household, poverty, population density, and parental history of asthma. Similar findings were seen for early and persistent wheeze. Even after adjusting for census variables such as household income, race and ethnicity persisted as risk factors for increased risk of asthma and/or wheeze.

Factors associated with asthma and wheeze included neighborhood socioeconomic factors, race, and ethnicity. Risk for asthma and wheeze remained higher for Black and Hispanic children compared with white children, even after adjusting for neighborhood factors such as poverty and household income. These results reflect structural and social determinants of health that can adversely affect the care of Black and Hispanic children.

Healthcare providers should recognize that root causes of asthma disparities, including racism, discrimination within healthcare setting, and access to healthcare resources, can lead to increased morbidity and mortality in Black and Hispanic children. Findings from this longitudinal cohort study support the need for adjustment in current healthcare policies and new interventions to reduce asthma disparities in the United States.