Where children with asthma live may increase their odds of visiting the ER

Social circumstances including a lack of safe housing, healthy foods and support networks have long been associated with poorer health outcomes.

Scientists have studied the ways these environmental and social determinants of health affect people’s overall well-being, but until now, little has been known about how living in neighborhoods of varying opportunity levels impacts health.

To assess one aspect of this scenario, researchers with the Texas A&M University Southwest Rural Health Research Center, housed in the School of Public Health, analyzed how race, ethnicity and moving from one neighborhood to another affects children’s odds of visiting the emergency room (ER) for asthma.

“More than half a million children in the United States receive care for asthma in emergency departments each year, making this their most common means of getting treatment,” said Nima Khodakarami, PhD, the study’s lead author. “These visits are costly, averaging $624 per child, and nearly one-third are potentially preventable.”

He added that because of this, addressing the social determinants of health in order to reduce these visits is a key objective in the national Healthy People 2030 initiative.

For their study, Khodakarami and center colleagues Marvellous Akinlotan, BDS, PhD, and Alva O. Ferdinand, DrPH, JD, examined the relationship between children’s asthma-related emergency department visits and the Child Opportunity Index (COI), which scores every neighborhood in the United States on overall quality of life. Their findings were published in Public Health Reports.

This analysis was conducted across COI neighborhoods with various levels of resources (from very low to very high) in the areas of education, health and environment, social and economic factors, and an overall metric combining all three domains.

They focused on 343,886 children from 2 to 17 years old in nine U.S. states (Arizona, Florida, Kentucky, Maryland, New Jersey, North Carolina, Oregon, Rhode Island and Wisconsin) for which 2016-2019 data were readily available and not cost-prohibitive from the Agency for Healthcare Research and Quality.

“To our knowledge, the only other study that looked at the influence of race and ethnicity at all levels of COI focused on patients with diabetes,” Akinlotan said. “In addition, several studies have examined the relationship between the COI metric and emergency department visits, but they focused on a small number of hospitals or on inpatient use.”

She added that while the study did not establish a causal relationship between the levels of opportunity in a child’s neighborhood and the likelihood of ER visits for asthma, its approach and large sample size generated greater confidence in the observed effects than was the case in prior studies.

Statistical analyses revealed that children living in neighborhoods with very low COI had a high probability of visiting the ER for asthma. This effect was largest in areas that scored lowest on health and environmental opportunities.

In addition, moving from a low to a very low COI neighborhood significantly increased the probability of asthma-related ER visits among children aged 5 to 9 years, Black children, boys and those living in large metropolitan areas.

In the case of Black children, the neighborhood effects were nearly three times greater than those for white children. In addition, across all COI levels, Black children were most likely to visit an emergency department for asthma during the study period.

“This aligns with a 2021 report from the Centers for Disease Control and Prevention, which found that asthma was highest among Black children, boys and children older than age 5,” Ferdinand said. “Our findings suggest that policy efforts to enhance neighborhood resources in disadvantaged areas may not only be beneficial to the social circumstances in which some families exist, but to the health of children who live with asthma and to the overall cost of their care.”