Skip to main content
SpringerLink
Log in

Does Living near Trees and Other Vegetation Affect the Contemporaneous Odds of Asthma Exacerbation among Pediatric Asthma Patients?

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

Vegetation may influence asthma exacerbation through effects on aeroallergens, localized climates, air pollution, or children’s behaviors and stress levels. We investigated the association between residential vegetation and asthma exacerbation by conducting a matched case–control study based on electronic health records of asthma patients, from the Children’s Hospital of Philadelphia (CHOP). Our study included 17,639 exacerbation case events and 34,681 controls selected from non-exacerbation clinical visits for asthma, matched to cases by age, sex, race/ethnicity, public payment source, and residential proximity to the CHOP main campus ED and hospital. Overall greenness, tree canopy, grass/shrub cover, and impervious surface were assessed near children’s homes (250 m) using satellite imagery and high-resolution landcover data. We used generalized estimating equations to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations between each vegetation/landcover measure and asthma exacerbation, with adjustment for seasonal and sociodemographic factors—for all cases, and for cases defined by diagnosis setting and exacerbation frequency. Lower odds of asthma exacerbation were observed in association with greater levels of tree canopy near the home, but only for children who experienced multiple exacerbations in a year (OR = 0.94 per 10.2% greater tree canopy coverage, 95% CI = 0.90–0.99). Our findings suggest possible protection for asthma patients from tree canopy, but differing results by case frequency suggest that potential benefits may be specific to certain subpopulations of asthmatic children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bryant-Stephens T. Asthma disparities in urban environments. J Allergy Clinical Immunol. 2009;123(6):1199–206.

    Article  Google Scholar 

  2. Ferrante G, La Grutta S. The burden of pediatric asthma (editorial). Front Pediatr. 2018;6:186.

    Article  Google Scholar 

  3. Nunes C, Pereira AM, Morais-Almeida M. Asthma costs and social impact. Asthma Res Pract. 2017;3:1.

    Article  Google Scholar 

  4. Perry R, Braileanu G, Palmer T, Stevens P. The economic burden of pediatric asthma in the United States: literature review of current evidence. Pharmacoeconom. 2019;37(2):155–67.

    Article  Google Scholar 

  5. Keet CA, Matsui EC, McCormack MC, Peng RD. Urban residence, neighborhood poverty, race/ethnicity, and asthma morbidity among children on Medicaid. J Allergy Clin Immunol. 2017;140(3):822–7.

    Article  Google Scholar 

  6. Zheng XY, Ding H, Jiang LN, et al. 2015 Association between air pollutants and asthma emergency room visits and hospital admissions in time series studies: a systematic review and meta-analysis. PLoS One;10(9):e0138146.

  7. Markevych I, Schoierer J, Hartig T, et al. Exploring pathways linking greenspace to health: theoretical and methodological guidance. Environ Res. 2017;158:301–17.

    Article  CAS  Google Scholar 

  8. De Roos AJ, Kenyon CC, Zhao Y, et al. 2020 Ambient daily pollen levels in association with asthma exacerbation among children in Philadelphia, Pennsylvania. Environ Int.;145:106138.

  9. Lovasi GS, Quinn JW, Neckerman KM, Perzanowski MS, Rundle A. Children living in areas with more street trees have lower prevalence of asthma. J Epidemiol Community Health. 2008;62(7):647–9.

    Article  CAS  Google Scholar 

  10. Chen E, Miller GE, Shalowitz MU, et al. 2017 Difficult family relationships, residential greenspace, and childhood asthma. Pediatrics.;139(4):e20163056.

  11. Tischer C, Gascon M, Fernández-Somoano A, et al. Urban green and grey space in relation to respiratory health in children. Eur Respir J. 2017;49(6):1502112.

    Article  Google Scholar 

  12. Alcock I, White M, Cherrie M, et al. Land cover and air pollution are associated with asthma hospitalisations: a cross-sectional study. Environ Int. 2017;109:29–41.

    Article  CAS  Google Scholar 

  13. DePriest K, Butz A, Curriero FC, Perrin N, Gross D. Associations among neighborhood greenspace, neighborhood violence, and children’s asthma control in an urban city. Ann Allergy Asthma Immunol. 2019;123(6):608–10.

    Article  Google Scholar 

  14. Dzhambov AM, Lercher P, Rüdisser J, Browning MHEM, Markevych I. 2021 Allergic symptoms in association with naturalness, greenness, and greyness: a cross-sectional study in schoolchildren in the Alps. Environ Res.;198:110456.

  15. Parmes E, Pesce G, Sabel CE, et al. 2020 Influence of residential land cover on childhood allergic and respiratory symptoms and diseases: evidence from 9 European cohorts. Environ Res.;183:108953.

  16. Kim D, Ahn Y. The contribution of neighborhood tree and greenspace to asthma emergency room visits: an application of advanced spatial data in Los Angeles County. Int J Environ Res Public Health. 2021;18(7):3487.

    Article  Google Scholar 

  17. Pennsylvania Department of Health. Pennsylvania Asthma Burden Report (2012). http://www.paasthma.org/images/docs/2012_asthma_burden_report.pdf. Accessed March 14, 2021.

  18. Asthma and Allergy Foundation of America (AAFA). Asthma Capitals 2019: the most challenging places to live with asthma. https://www.aafa.org/asthma-capitals/. Accessed March 14, 2021.

  19. Delaware Valley Regional Planning Commission (DVRPC). Health Data Snapshot. https://www.dvrpc.org/health/PASnapshot/. Accessed March 14, 2021.

  20. Nowak DJ, Bodine AR, Hoehn R, et al. The urban forests of Philadelphia. Resource Bulletin NRS-106. Newtown Square, PA: US Department of Agriculture, Forest Service, Northern Research Station. 2016;106:1–80.

  21. Fuhlbrigge A, Peden D, Apter AJ, et al. Asthma outcomes: exacerbations. J Allergy Clin Immunol. 2012;129(3 Suppl):S34-48.

    Article  Google Scholar 

  22. Kenyon CC, Maltenfort MG, Hubbard RA, et al. Variability in diagnosed asthma in young children in a large pediatric primary care network. Acad Pediatr. 2020;20(7):958–66.

    Article  Google Scholar 

  23. Mudd AE, Michael YL, Diez-Roux AV, et al. Primary care accessibility effects on health care utilization among urban children. Acad Pediatr. 2020;20(6):871–8.

    Article  Google Scholar 

  24. Carroll ML, DiMiceli CM, Sohlberg RA, Townshend JR. 250m MODIS normalized difference vegetation index. College Park, MD: University of Maryland; 2004.

    Google Scholar 

  25. O’Neil-Dunne JP, Grove JM. A report on the City of Philadelphia’s existing and possible tree canopy. Washington, DC: USDA Forest Service; 2011.

    Google Scholar 

  26. Philadelphia Land Cover Raster 2018. University of Vermont Spatial Analysis Laboratory. http://www.pasda.psu.edu/uci/DataSummary.aspx?dataset=3193. Accessed November 7, 2016.

  27. National Land Cover Database. www.mrlc.gov. Accessed April 19, 2016.

  28. American Community Survey (ACS0509 & ACS1216). U.S. Census. https://www.census.gov/programs-surveys/acs. Accessed 2018

  29. Diez Roux AV, Merkin SS, Arnett D, et al. Neighborhood of residence and incidence of coronary heart disease. New Engl Journal Med. 2001;345:99–106.

    Article  CAS  Google Scholar 

  30. Berrocal VJ, Gelfand AE, Holland DM. A spatio-temporal downscaler for output from numerical models. J Agric Biol Environ Stat. 2010;15(2):176–97.

    Article  Google Scholar 

  31. Berrocal VJ, Gelfand AE, Holland DM. Space-time data fusion under error in computer model output: an application to modeling air quality. Biometrics. 2012;68(3):837–48.

    Article  Google Scholar 

  32. NOAA, National Centers for Environmental Information. https://www.ncdc.noaa.gov/cdo-web/datatools/lcd. Accessed 2017–2018.

  33. National Asthma Education and Prevention Program. Third Expert Panel on the Diagnosis and Management of Asthma. Expert Panel Report 3: guidelines for the diagnosis and management of asthma. Bethesda, MD: National Heart Lung and Blood Institute. 2007. Available from https://www.ncbi.nml.gov/books/NBK7232/. Accessed October 2021

  34. Pearsall H, De Roos AJ, Dickinson S, et al. The benefits and costs of urban public spaces. Philadelphia, PA: William Penn Foundation, 2020. https://williampennfoundation.org/what-we-are-learning/benefits-and-costs-urban-public-spaces. Accessed November 3, 2021.

  35. Kanchongkittiphon W, Mendell MJ, Gaffin JM, Wang G, Phipatanakul W. Indoor environmental exposures and exacerbation of asthma: an update to the 2000 review by the Institute of Medicine. Environ Health Perspect. 2015;123(1):6–20.

    Article  Google Scholar 

Download references

Acknowledgements

This study is part of the Pediatric Big Health Data initiative funded by the State of Pennsylvania and led by the Children’s Hospital of Philadelphia, University of Pennsylvania, and the Urban Health Collaborative at Drexel University. We would like to thank the investigators of the Pediatric Big Health Data initiative for their contributions. These individuals include the following: Christopher B. Forrest, MD, PhD; L. Charles Bailey, MD, PhD; Shweta P. Chavan, MSEE; Rahul A. Darwar, MPH; Jillian Benedetti, MPH; Daniel Forsyth; Chén C. Kenyon, MD, MSHP; Ritu Khare, PhD; Mitchell G. Maltenfort, PhD; Aaron J. Masino, PhD, ME; Xueqin Pang, PhD; Ting Qian, PhD; Hanieh Razzaghi, MPH; Justine Shults, PhD; Levon H. Utidjian, MD, MBI from the Children’s Hospital of Philadelphia; Ana V. Diez Roux, MD, PhD, MPH; Amy H. Auchincloss, PhD, MPH; Elizabeth A. Campbell, MSPH; Kimberly Daniels, MS; Anneclaire J. De Roos, PhD, MPH; J. Felipe Garcia-Espana, MS, PhD; Irene Headen, PhD, MS; Félice Lê-Scherban, PhD, MPH; Steven Melly, MS, MA; Yvonne L. Michael, ScD, SM; Jeffrey Moore, MS; Kari Moore, MS; Abigail E. Mudd, MPH; Leah Schinasi, PhD, MSPH; and Yuzhe Zhao, MS from Drexel University and, Yong Chen, PhD; John H. Holmes, PhD; Rebecca A. Hubbard, PhD; A. Russell Localio, JD, MPH, PhD from the University of Pennsylvania.

This work was supported by a grant from the Commonwealth Universal Research Enhancement (C.U.R.E) program funded by the Pennsylvania Department of Health—2015 Formula award—SAP #4100072543.

Anneclaire J. De Roos would like to acknowledge the Whiteley Center at the University of Washington Friday Harbor Laboratories for providing a peaceful and inspirational setting in which to complete the bulk of this research.

Author information

Authors and Affiliations

  1. Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA

    Anneclaire J. De Roos, Yun-Ting Yen & Leah H. Schinasi

  2. Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA

    Anneclaire J. De Roos, Kari Moore, Steven Melly, Ana V. Diez Roux & Leah H. Schinasi

  3. Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Chén C. Kenyon, Mitchell Maltenfort & Christopher B. Forrest

  4. Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Rebecca A. Hubbard

  5. Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA

    Ana V. Diez Roux

Authors
  1. Anneclaire J. De Roos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chén C. Kenyon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yun-Ting Yen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kari Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Steven Melly
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rebecca A. Hubbard
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mitchell Maltenfort
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Christopher B. Forrest
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ana V. Diez Roux
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Leah H. Schinasi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anneclaire J. De Roos.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

De Roos, A.J., Kenyon, C.C., Yen, YT. et al. Does Living near Trees and Other Vegetation Affect the Contemporaneous Odds of Asthma Exacerbation among Pediatric Asthma Patients?. J Urban Health 99, 533–548 (2022). https://doi.org/10.1007/s11524-022-00633-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-022-00633-7

Keywords

Search

Navigation