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Comment
. 2022 Aug 1;176(8):759-767.
doi: 10.1001/jamapediatrics.2022.1446.

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

Antonella Zanobetti  1 , Patrick H Ryan  2   3 , Brent Coull  4 , Cole Brokamp  2   3 , Soma Datta  5 , Jeffrey Blossom  6 , Nathan Lothrop  7   8 , Rachel L Miller  9 , Paloma I Beamer  7   8 , Cynthia M Visness  10 , Howard Andrews  11 , Leonard B Bacharier  12 , Tina Hartert  13 , Christine C Johnson  14 , Dennis Ownby  15 , Gurjit K Khurana Hershey  16 , Christine Joseph  14 , Song Yiqiang  17 , Eneida A Mendonça  18 , Daniel J Jackson  19 , Heike Luttmann-Gibson  1 , Edward M Zoratti  20 , Anne L Wright  7   21 , Fernando D Martinez  7   21 , Christine M Seroogy  19 , James E Gern  20 , Diane R Gold  1   5 ; Children’s Respiratory and Environmental Workgroup (CREW) Consortium
Collaborators, Affiliations
Comment

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

Antonella Zanobetti et al. JAMA Pediatr. .

Erratum in

  • Error in Author's Name.
    [No authors listed] [No authors listed] JAMA Pediatr. 2022 Aug 1;176(8):829. doi: 10.1001/jamapediatrics.2022.2518. JAMA Pediatr. 2022. PMID: 35913493 Free PMC article. No abstract available.

Abstract

Importance: In the United States, Black and Hispanic children have higher rates of asthma and asthma-related morbidity compared with White children and disproportionately reside in communities with economic deprivation.

Objective: To determine the extent to which neighborhood-level socioeconomic indicators explain racial and ethnic disparities in childhood wheezing and asthma.

Design, setting, and participants: The study population comprised children in birth cohorts located throughout the United States that are part of the Children's Respiratory and Environmental Workgroup consortium. Cox proportional hazard models were used to estimate hazard ratios (HRs) of asthma incidence, and logistic regression was used to estimate odds ratios of early and persistent wheeze prevalence accounting for mother's education, parental asthma, smoking during pregnancy, child's race and ethnicity, sex, and region and decade of birth.

Exposures: Neighborhood-level socioeconomic indicators defined by US census tracts calculated as z scores for multiple tract-level variables relative to the US average linked to participants' birth record address and decade of birth. The parent or caregiver reported the child's race and ethnicity.

Main outcomes and measures: Prevalence of early and persistent childhood wheeze and asthma incidence.

Results: Of 5809 children, 46% reported wheezing before age 2 years, and 26% reported persistent wheeze through age 11 years. Asthma prevalence by age 11 years varied by cohort, with an overall median prevalence of 25%. Black children (HR, 1.47; 95% CI, 1.26-1.73) and Hispanic children (HR, 1.29; 95% CI, 1.09-1.53) were at significantly increased risk for asthma incidence compared with White children, with onset occurring earlier in childhood. Children born in tracts with a greater proportion of low-income households, population density, and poverty had increased asthma incidence. Results for early and persistent wheeze were similar. In effect modification analysis, census variables did not significantly modify the association between race and ethnicity and risk for asthma incidence; Black and Hispanic children remained at higher risk for asthma compared with White children across census tracts socioeconomic levels.

Conclusions and relevance: Adjusting for individual-level characteristics, we observed neighborhood socioeconomic disparities in childhood wheeze and asthma. Black and Hispanic children had more asthma in neighborhoods of all income levels. Neighborhood- and individual-level characteristics and their root causes should be considered as sources of respiratory health inequities.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Zanobetti reported grants from National Institutes of Health (NIH) during the conduct of the study and grants from National Institute on Aging outside the submitted work. Drs Ryan, Coull, and Miller reported grants from NIH during the conduct of the study. Dr Beamer reported grants from NIH during the conduct of the study and grants from NIH and the Environmental Protection Agency outside the submitted work. Dr Hartert reported grants from NIH and the World Health Organization during the conduct of the study and personal fees from Pfizer and Sanofi-Pasteur outside the submitted work. Dr Bacharier reported grants from NIH/National Institute of Allergy and Infectious Diseases (NIAID) during the conduct of the study and personal fees from GlaxoSmithKline, Genentech/Novartis, Merck, DBV Technologies, Teva, Boehringer Ingelheim, AstraZeneca, Webscape/WebMD, Sanofi/Regeneron, Circassia, Vertex, and Elsevier outside the submitted work. Dr Ownby reported grants from NIH during the conduct of the study. Dr Zoratti reported grants from NIAID during the conduct of the study. Dr Wright reported grants from NIH during the conduct of the study. Dr Martinez reported grants from Office of the Director (UH30OD023282) during the conduct of the study and grants from NIH/National Heart, Lung, and Blood Institute (HL132523, HL139054, HL091889, HL130045, HL098112, HL056177, HL137851, HL132523), NIH/NIAID (AI126614, AI148104), and NIH/National Institute of Environmental Health Sciences (NIEHS) (ES006614) outside the submitted work. Dr Seroogy reported grants from NIH during the conduct of the study and outside the submitted work. Dr Johnson reported grants from NIH during the conduct of the study. Dr Jackson reported grants from NIH during the conduct of the study and grants and/or personal fees from GlaxoSmithKline, Sanofi, Regeneron, Novartis, Pfizer, and Vifor Pharma outside the submitted work. Dr Gern reported grants from NIH during the conduct of the study and personal fees from AstraZeneca and Gossamer Bio outside the submitted work. Dr Gold reported grants from NIH during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Kaplan-Meier Curves for Child’s Race and Ethnicity and for Census Characteristics
Figure 2.
Figure 2.. Hazard Ratios of Asthma Incidence for 1–z Score Increase in Census Tract–Level Socioeconomic Factors
Model 1: logistic model adjusting for child’s sex, decade of birth, geographic region, and parental history of asthma. Model 2: model 1 plus adjustment for child’s race and ethnicity, mother’s education, and smoking during pregnancy.
Figure 3.
Figure 3.. Effect Modification of Individual Race and Ethnicity by Selected Neighborhood Socioeconomic Factors
Results are presented as hazard ratios of asthma incidence for Black and Hispanic race and ethnicity compared with White as reference, for each neighborhood socioeconomic factor category.
Figure 4.
Figure 4.. Odds Ratios of Persistent Wheeze and Early Wheeze for 1–z Score Increase in Each Neighborhood Socioeconomic Factor
Model 1: logistic model adjusting for child’s sex, decade of birth, geographic region, and parental history of asthma. Model 2: model 1 plus adjustment for child’s race and ethnicity, mother’s education, and smoking during pregnancy.
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Comment on

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