Child Opportunity Index at birth and asthma with recurrent exacerbations in the US ECHO program
Recommended Citation
Miller RL, Schuh H, Chandran A, Habre R, Angal J, Aris IM, Aschner JL, Bendixsen CG, Blossom J, Bosquet-Enlow M, Breton CV, Camargo CA, Jr., Carroll KN, Commodore S, Croen LA, Dabelea DM, Deoni SCL, Ferrara A, Fry RC, Ganiban JM, Geiger SD, Gern JE, Gilliland FD, Gogcu S, Gold DR, Hare ME, Harte RN, Hartert TV, Hertz-Picciotto I, Hipwell AE, Jackson DJ, Karagas MK, Khurana Hershey GK, Kim H, Litonjua AA, Marsit CJ, McEvoy CT, Mendonça EA, Moore PE, Nguyen AP, Nkoy FL, O'Connor TG, Oken E, Ownby DR, Perzanowski M, Rivera-Spoljaric K, Sathyanarayana S, Singh AM, Stanford JB, Stroustrup A, Towe-Goodman N, Wang VA, Woodruff TJ, Wright RO, Wright RJ, Zanobetti A, Zoratti EM, and Johnson CC. Child Opportunity Index at Birth and Asthma with Recurrent Exacerbations in the U.S. ECHO Program. J Allergy Clin Immunol 2025.
Document Type
Article
Publication Date
3-13-2025
Publication Title
The Journal of allergy and clinical immunology
Abstract
BACKGROUND: Environmental exposures and social determinants likely influence specific childhood asthma phenotypes.
OBJECTIVE: We hypothesized that the Child Opportunity Index (COI) at birth, measuring multiple neighborhood opportunities, influences incidence rates (IRs) for asthma with recurrent exacerbations (ARE).
METHODS: We tested for COI associations with ARE IRs in 15,877 children born between 1990 and 2018 in the ECHO (Environmental Influences on Child Health Outcomes) program. Parent-reported race and ethnicity and other demographics were assessed as effect modifiers.
RESULTS: The IRs of ARE for children born in very low COI neighborhoods was higher (IR = 10.98; 95% CI: 9.71, 12.25) than for other COI categories. Rates for non-Hispanic Black (NHB) children were significantly higher than non-Hispanic White children in every COI category. The ARE IRs for children born in very low COI neighborhoods were several-fold higher for NHB and Hispanic Black children (IR = 15.30; 95% CI: 13.10, 17.49; and IR = 18.48; 95% CI: 8.80, 28.15, respectively) when compared to White children. Adjusting for individual-level characteristics, children born in very low COI neighborhoods demonstrated an ARE IR ratio of 1.26 (95% CI: 0.99, 1.59) with a higher incidence of cases among children ages 2 to 4 years and with a parental history of asthma.
CONCLUSIONS: Rates of ARE were higher among children born in under-resourced communities, and this relationship is strongest for young minoritized children with a parental history of asthma. Higher rates for NHB even in the highest COI categories suggest that risk associated with race persists regardless of social disadvantage.
Medical Subject Headings
Child; Child; Preschool; Female; Humans; Infant; Male; Asthma/epidemiology; Black or African American; Environmental Exposure/adverse effects; Incidence; Neighborhood Characteristics; Recurrence; United States/epidemiology; White; Asthma; child opportunity index; environmental and social determinants of asthma; incidence rates; recurrent asthma exacerbations
PubMed ID
40089117
ePublication
ePub ahead of print
Volume
156
Issue
3
First Page
627
Last Page
639
