Skip to main content

Comprehensive Neighborhood Portraits and Child Asthma Disparities

Maternal and Child Health Journal volume 21, pages 1552–1562 (2017)Cite this article

Abstract

Objectives Previous research has established links between child, family, and neighborhood disadvantages and child asthma. We add to this literature by first characterizing neighborhoods in Houston, TX by demographic, economic, and air quality characteristics to establish differences in pediatric asthma diagnoses across neighborhoods. Second, we identify the relative risk of social, economic, and environmental risk factors for child asthma diagnoses. Methods We geocoded and linked electronic pediatric medical records to neighborhood-level social and economic indicators. Using latent profile modeling techniques, we identified Advantaged, Middle-class, and Disadvantaged neighborhoods. We then used a modified version of the Blinder-Oaxaca regression decomposition method to examine differences in asthma diagnoses across children in these different neighborhoods. Results Both compositional (the characteristics of the children and the ambient air quality in the neighborhood) and associational (the relationship between child and air quality characteristics and asthma) differences within the distinctive neighborhood contexts influence asthma outcomes. For example, unequal exposure to PM2.5 and O3 among children in Disadvantaged and Middle-class neighborhoods contribute to asthma diagnosis disparities within these contexts. For children in Disadvantaged and Advantaged neighborhoods, associational differences between racial/ethnic and socioeconomic characteristics and asthma diagnoses explain a significant proportion of the gap. Conclusions for Practice Our results provide evidence that differential exposure to pollution and protective factors associated with non-Hispanic White children and children from affluent families contribute to asthma disparities between neighborhoods. Future researchers should consider social and racial inequalities as more proximate drivers, not merely as associated, with asthma disparities in children.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

39,95 €

Price includes VAT (Finland)

Notes

  1. Difference sums to more than total difference because of the negative estimates for other factors such as race/ ethnicity that offset asthma diagnoses differences.

  2. Some researchers suggest this unexplained portion reflects discrimination (e.g., (Kim 2013)).

References

  • Akinbami, L. J., Simon, A. E., & Rossen, L. M. (2016). Changing trends in asthma prevalence among children. Pediatrics, 137(1), e20152354.

    Article  Google Scholar 

  • Akinbami, L. J., Moorman, J. E., Simon, A. E., & Schoendorf, K. C. (2014). Trends in racial disparities for asthma outcomes among children 0 to 17 years, 2001–2010. Journal of Allergy and Clinical Immunology, 134(3), 547–553.

    Article  PubMed  PubMed Central  Google Scholar 

  • Akinbami, L. J., Rhodes, J. C., & Lara, M. (2005). Racial and ethnic differences in asthma diagnosis among children who wheeze. Pediatrics, 115(5), 1254–1260.

    Article  PubMed  Google Scholar 

  • Ash, M., & Fetter, T. R. (2004). Who lives on the wrong side of the environmental tracks? Evidence from the EPAs risk-screening environmental indicators model. Social Science Quarterly, 85(2), 441–462.

    Article  Google Scholar 

  • Ayanian, J. Z., Kohler, B. A., Abe, T., & Epstein, A. M. (1993). The relation between health insurance coverage and clinical outcomes among women with breast cancer. New England Journal of Medicine, 329, 326–331. doi:10.1056/NEJM199307293290507.

    Article  CAS  PubMed  Google Scholar 

  • Blinder, A. S. (1973). Wage discrimination: Reduced form and structural estimates. Journal of Human Resources, 8(4), 436–455.

    Article  Google Scholar 

  • Brandt, S. J., Perez, L., KĂĽnzli, N., Lurmann, F., & McConnell, R. (2012). Costs of childhood asthma due to traffice-related pollution in two California communities. The European Respiratory Journal, 40(2), 363–370.

    Article  PubMed  PubMed Central  Google Scholar 

  • Breysse, P. N., Diette, G. B., Matsui, E. C., Butz, A. M., Hansel, N. N., & McCormack, M. C. (2010). Indoor air pollution and asthma in children. Proceedings of the American Thoracic Society, 7(2), 102–106.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Brisbon, N., Plumb, J., Brawer, R., & Paxman, D. (2005). The asthma and obesity epidemics: the role played by the built environment: A public health perspective. Journal of Allergy and Clinical Immunology, 115(5), 1024–1028.

    Article  PubMed  Google Scholar 

  • Byrd, R. S., & Joad, J. P. (2006). Urban asthma. Current Opinion Pulmonary Medicine, 12(1), 68–74.

    Article  Google Scholar 

  • CDC—National Center for Health Statistics—Homepage. Retrieved February 17, 2016 from http://www.cdc.gov/nchs/.

  • Crowder, K., & Downey, L. (2010). Inter-neighborhood migration, race, and environmental hazards: Modeling micro-level processes of environmental inequality. American Journal of Sociology, 115(4), 1110–1149.

    Article  Google Scholar 

  • Eder, W., & Ege, M. J., & Von Mutius, E. (2006). The asthma epidemic. New England Journal of Medicine, 355(21), 2226–2235.

    Article  CAS  PubMed  Google Scholar 

  • Esposito, S., Tenconi, R., Lelii, M., Preti, V., Nazzari, E., Consolo, S., & Patria, M. F. (2014). Possible molecular mechanisms linking air pollution and asthma in children. BMC Pulmonary Medicine, 14, 31–40.

    Article  PubMed  PubMed Central  Google Scholar 

  • Foraker, R. E., Rose, K. M., Whitsel, E. A., Suchindran, C. M., Wood, J. L., & Rosamond, W. D. (2010). Neighborhood socioeconomic status, Medicaid coverage and medical management of myocardial infarction: Atherosclerosis risk in communities (ARIC) community surveillance. BMC Public Health, 10, 632. doi:10.1186/1471-2458-10-632

    Article  PubMed  PubMed Central  Google Scholar 

  • Goldizen, F. C., Sly, P. D., & Knibbs, L. D. (2015). Respiratory effects of air pollution on children. Pediatric Pulmonology. doi:10.1002/ppul.23262.

    PubMed  Google Scholar 

  • Groneberg-Kloft, B., Kraus, T., van Mark, A., Wagner, U., & Fischer, A. (2006). Analyzing the causes of chronic cough: relation to diesel exhaust, ozone, nitrogen oxides, sulfur oxides and other environmental factors. Journal of Occupational Medical Toxicology, 1, 6–16.

    Article  Google Scholar 

  • Harnick, D. J., Cohen, J. L., Schechter, C. B., Fuster, V., & Smith, D. A. (1998). Effects of practice setting on quality of lipid-lowering management in patients with coronary artery disease. American Journal of Cardiology, 81, 1416–1420. doi:10.1016/S0002-9149(98)00209-4.

    Article  CAS  PubMed  Google Scholar 

  • Horton, N. J., Roberts, K., Ryan, L., Franco Suglia, S., & Wright, R. J. (2008). A maximum likelihood latent variable regression model for multiple informants. Statistics in Medicine, 27(24), 4992–5004.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kim, C. H. (2013). Detailed wage decompositions: Revisiting the identification problem. Composition, Context, and. Structure (London, England: 1993), 43(1), 346–363.

    Google Scholar 

  • Mitchell, E., Stewart, A., Pattermore, P., et al. (1989). Socioeconomic status in childhood asthma. International Journal of Epidemiology, 18, 888–890.

    Article  CAS  PubMed  Google Scholar 

  • Oaxaca, R. (1973). Male-female wage differentials in urban labor markets. International Economic Review, 14(3), 693–709.

    Article  Google Scholar 

  • Pais, J., Crowder, K., & Downey, L. (2013). Unequal trajectories: Racial and class differences in residential exposure to industrial hazard. Social Forces. doi:10.1093/sf/sot099.

    Google Scholar 

  • Pope, C. A., & Dockery, D. W. (2006). Health effects of particulate air pollution: Lines that connect. Journal of Air and Waste Management, 56, 709–742.

    Article  CAS  Google Scholar 

  • Pride, N. B. (1992). Asthma. Definition and clinical spectrum. British Medical Bulletin, 48(1), 1–9.

    Article  CAS  PubMed  Google Scholar 

  • Rodriquez, M., & Alexeeff, G. V. (2014). California communities environmental health screening tool, version 2.0. http://oehha.ca.gov/media/CES20FinalReportUpdateOct2014.pdf.

  • Rosenbaum, S. (2002). Medicaid. New England Journal of Medicine, 346, 635–640. doi:10.1056/NEJM200202213460825.

    Article  PubMed  Google Scholar 

  • Sampson, R. J. (2008). Moving to inequality: Neighborhood effects and experiments meet social structure. American Journal of Sociology, 114(1), 189–231.

    Article  Google Scholar 

  • Sandel, M., & Wright, R. J. (2006). When home is where the stress is: expanding the dimensions of housing that influence asthma morbidity. Archives of Disease in Childhood, 91(11), 942–948.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Schwartz, J. (2004). Air pollution and children’s health. Pediatrics, 113(4 suppl), 1037–1043.

    PubMed  Google Scholar 

  • Shen, J. J., Wan, T. T., & Perlin, J. B. (2001). An exploration of the complex relationship of socioecologic factors in the treatment and outcomes of acute myocardial infarction in disadvantaged populations. Health Services Research, 36, 711–732.

    CAS  PubMed  PubMed Central  Google Scholar 

  • von Hertzen, L. C. (2002). Maternal stress and T-cell differentiation of the developing immune system: possible implications for the development of asthma and atopy. Journal of Allergy and Clinical Immunology, 109, 923–928.

    Article  Google Scholar 

  • Weiss, K. B., & Wagener, D. K. (1990). Changing patterns of asthma mortality: identifying target populations at high risk. JAMA, 264, 1683–1687.

    Article  CAS  PubMed  Google Scholar 

  • Weitzman, M., Gortmaker, S., & Sobol, A. (1990). Racial, social, and environmental risks of childhood asthma. American Journal of Diseases of Children, 144, 1189–1194.

    CAS  PubMed  Google Scholar 

  • Wickerham, E., & Bhakta, N. (2013). Asthma Hospitalization Rates and Prevalence Among Children in the Greater Houston Area, Texas: Texas Department of State Health Services, 2011. Available at https://www.dshs.texas.gov/asthma/data.shtm.

  • Williams, D. R., Strenthal, M., & Wright, R. J. (2009). Social determinates: Taking the social context of asthma seriously. Pediatrics, 123(3), S174–S184.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wright, R. J., Mitchell, H., Visness, C. M., et al. (2004). Community violence and asthma morbidity: the Inner-City Asthma Study. American Journal of Public Health, 94(4), 625–632.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wright RJ, & Fisher EB. (2003). Putting asthma into context: Community influences on risk, behavior, and intervention. In: I. Kawachi & L. F. Berkman (Eds.), Neighborhoods and health (233–262). New York: Oxford University Press.

    Chapter  Google Scholar 

  • Wright, R. & Subramanian, S.V. (2007). Advancing a multilevel framework for epidemiologic research on asthma disparities. CHEST, 132, 757S–769S.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Sociology, Kinder Institute Urban Health Program, Rice University, 6500 Main Street #1020, Houston, TX, 77030, USA

    Ashley W. Kranjac, Rachel T. Kimbro & Justin T. Denney

  2. Department of Public Health, University of Illinois— Springfield, Springfield, IL, USA

    Kristin M. Osiecki

  3. Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA

    Brady S. Moffett & Keila N. Lopez

Authors
  1. Ashley W. Kranjac
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rachel T. Kimbro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Justin T. Denney
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kristin M. Osiecki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Brady S. Moffett
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Keila N. Lopez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ashley W. Kranjac.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kranjac, A.W., Kimbro, R.T., Denney, J.T. et al. Comprehensive Neighborhood Portraits and Child Asthma Disparities. Matern Child Health J 21, 1552–1562 (2017). https://doi.org/10.1007/s10995-017-2286-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-017-2286-z

Keywords

  • Asthma
  • Children and youth
  • Neighborhood disadvantage
  • Environmental quality
  • Quantitative analysis