Residing in a low-income-low-food-access neighbourhood and asthma in early and middle childhood in the Environmental influences on Child Health Outcomes (ECHO) program: a multisite cohort study

Abstract

Importance: Access to healthy and affordable foods may play a role in reducing inflammation and in healthy pulmonary immune system development.

Objective: To investigate the association between residing in a low-income and low-food-access (LILA) neighbourhood and risk of childhood asthma. A positive association was hypothesised.

Design, setting and participants: This prospective cohort study consists of 16 012 children from 35 longitudinal studies in the Environmental influences on Child Health Outcomes programme (children born 1998-2021) from across the contiguous USA. We conducted survival analyses adjusted for child sex, race/ethnicity, maternal education, gestational smoking, and parental history of asthma.

Exposures: Several commonly used geospatial food access metrics were linked to residential locations including: LILA census tracts where the nearest supermarket is >1 mile in urban and >10 miles in rural areas (LILA_{1 and 10}), >1 mile in urban and >20 miles in rural areas (LILA_{1 and 20}), >0.5 mile in urban and >10 miles in rural areas (LILA_{0.5 and 10}), and >0.5 mile without a vehicle or >20 miles (LILA_vehicle). Each metric was linked to lifetime residential history timelines then dichotomised according to whether the child had spent at least 75% of their life living in a LILA area separately for birth through age 5 years (cumulative early childhood) and birth through age 11 years (cumulative middle childhood).

Main outcomess and measures: Asthma incidence in cumulative early and middle childhood.

Results: Residing in a LILA_{0.5 and 10} and LILA_vehicleneighbourhood was associated with a higher asthma incidence in cumulative early and middle childhood. The LILA_{0.5 and 10} and LILA_vehicle associations were stronger for asthma during cumulative early childhood, where we observed hazard ratios of 1.13 (95% CI 1.02 to 1.24) and 1.13 (95% CI 1.01 to 1.27), respectively. The associations were higher among children who were Hispanic, were female and had lower maternal education.

Conclusion and relevance: Limited residential food access was associated with higher childhood asthma incidence, especially among female and Hispanic children and those with lower maternal education. Our findings support multipronged efforts to increase access to healthy and affordable food options and lower food insecurity in LILA neighbourhoods.

Keywords: Asthma; Child; Community child health; PUBLIC HEALTH.

Figure 1. Modification of the association between residential low-income low-access (LILA) neighbourhoods and asthma in cumulative early childhood by participant characteristics. Black points represent the estimated HR of asthma incidence from birth through age 5 (early childhood) for each LILA metric by each potential individual-level modifier, and the error bars show the corresponding 95% CIs. The dotted black line denotes the null. HS: high school; LILA 0.5 and 10, >0.5 mile in urban and >10 miles in rural areas; LILA 1 and 10, nearest supermarket >1 mile in urban and >10 miles in rural areas; LILA 1 and 20, >1 mile in urban and >20 miles in rural areas; LILA vehicle, >100 households are >0.5 mile without a vehicle or >20 miles.

Figure 2. Modification of the association between residential low-income low-access (LILA) neighbourhoods and asthma in cumulative middle childhood by participant characteristics. Black points represent the estimated HR of asthma incidence from birth through age 11 (middle childhood) for each LILA metric by each potential individual-level modifier, and the error bars show the corresponding 95% CIs. The dotted black line denotes the null. HS: high school; LILA 1 and 10, nearest supermarket >1 mile in urban and >10 miles in rural areas; LILA 1 and 20, >1 mile in urban and >20 miles in rural areas;; LILA 0.5 and 10, >0.5 mile in urban and >10 miles in rural areas; LILA vehicle, >100 households are >0.5 mile without a vehicle or >20 miles.