Areas with High Rates of Police-Reported Violent Crime Have Higher Rates of Childhood Asthma Morbidity

Abstract

Objectives: To assess whether population-level violent (and all) crime rates were associated with population-level child asthma utilization rates and predictive of patient-level risk of asthma reutilization after a hospitalization.

Study design: A retrospective cohort study of 4638 pediatric asthma-related emergency department visits and hospitalizations between 2011 and 2013 was completed. For population-level analyses, census tract asthma utilization rates were calculated by dividing the number of utilization events within a tract by the child population. For patient-level analyses, hospitalized patients (n = 981) were followed until time of first asthma-related reutilization. The primary predictor was the census tract rate of violent crime as recorded by the police; the all crime (violent plus nonviolent) rate was also assessed.

Results: Census tract-level violent and all crime rates were significantly correlated with asthma utilization rates (both P < .0001). The violent crime rate explained 35% of the population-level asthma utilization variance and remained associated with increased utilization after adjustment for census tract poverty, unemployment, substandard housing, and traffic exposure (P = .002). The all crime rate explained 28% of the variance and was similarly associated with increased utilization after adjustment (P = .02). Hospitalized children trended toward being more likely to reutilize if they lived in higher violent (P = .1) and all crime areas (P = .01). After adjustment, neither relationship was significant.

Conclusions: Crime data could help facilitate early identification of potentially toxic stressors relevant to the control of asthma for populations and patients.

Keywords: Child Health; Geography; Neighborhood; Violence.

Figure 1

Map of the 104 City of Cincinnati, Ohio census tracts, displaying rates of violent crime incidents per 1,000 people per year (measured 2011–2013) with overlying asthma utilization events (emergency department visits and hospitalizations)

Figure 2

Kaplan Meier curves displaying patient-level time to reutilization (emergency department revisit or re-hospitalization) by quartiles of A, census tract violent crime rates and B, census tract all crime rates. P-values obtained using the log-rank test.

Figure 2

Kaplan Meier curves displaying patient-level time to reutilization (emergency department revisit or re-hospitalization) by quartiles of A, census tract violent crime rates and B, census tract all crime rates. P-values obtained using the log-rank test.