Understanding Racial Disparities in Childhood Asthma Using Individual- and Neighborhood-level Risk Factors

To investigate racial disparities in asthma-related emergency department visits between African American and European American children, considering both individual- and neighborhood-level factors.

Patients younger than 18 years who visited the Cincinnati Children’s emergency department (ED) for asthma between 2009 and 2018 and self-identified as African American (AA) or European American (EA).

This was a retrospective study using mediation and mixed-effects analyses to analyze the relationship between race, socioeconomic factors, environmental variables, and annual ED visit numbers. Patients’ geocoded addresses were linked to neighborhood-level variables such as proximity to roads and green space, socioeconomic deprivation index, and weekly averages of particulate matter, pollen, and outdoor mold.

This study included 31 114 children and 186 779 asthma-related ED visits. AA children had a higher rate of asthma-related ED visits compared with EA children (2.23 vs 2.15 visits per year; P < .001). Medicaid insurance was associated with an increased rate of ED visits. Neighborhood socioeconomic deprivation was associated with ED visits in AA but not EA children. Airborne particulate matter, pollen, and outdoor mold were associated with increased ED visits in both groups. Medicaid insurance status, area-level deprivation, particulate matter, and outdoor mold together accounted for 55% of the effect of race on ED visits. When controlled for mediators, race was not independently associated with ED visits.

AA children had higher rates of asthma-related ED visits and were more likely to live in socioeconomically deprived areas farther from green space and be exposed to pollutants and allergens. Medicaid-insured children used the ED more frequently than commercially insured children. The study highlighted the role of social, economic, and environmental factors at both individual and neighborhood levels in mediating racial disparities in asthma-related ED visits.

This is yet another study that demonstrates that social determinants of health, and not race, underlie asthma disparities. This information should inform health and environmental policy addressing air quality, green space, living conditions, and access to preventative care.