Childhood Asthma Incidence, Early and Persistent Wheeze, and Neighborhood Socioeconomic Factors in the ECHO/CREW Consortium
Childhood Asthma Incidence, Early and Persistent Wheeze, and Neighborhood Socioeconomic Factors in the ECHO/CREW Consortium
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DOI：
10.1001/jamapediatrics.2022.1446
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发表时间：
2022-05-23
期刊：
影响因子：
26.1
通讯作者：
Gold, Diane R.
中科院分区：
文献类型：
--
作者：
Zanobetti, Antonella;Ryan, Patrick H.;Gold, Diane R.
重要性 在美国，与白人儿童相比，黑人和西班牙裔儿童的哮喘和哮喘相关发病率较高，而且居住在经济贫困的社区的比例更高。 目的 确定社区一级的社会经济指标在多大程度上解释儿童喘息和哮喘的种族和民族差异。 设计、环境和参与者 研究人群包括美国各地出生队列中的儿童，这些儿童属于儿童呼吸系统疾病的一部分和环境工作组联盟。 Cox比例风险模型用于估计哮喘发病率的风险比（HRs），逻辑回归用于估计早期和持续性喘息患病率的比值比，其中考虑了母亲的教育程度、父母哮喘、怀孕期间吸烟、孩子的种族和民族、性别、出生的地区和十年。父母或照顾者报告了孩子的种族和民族。 主要结果和措施 儿童早期和持续性喘息的患病率和哮喘发病率。 结果 在 5809 名儿童中，46% 的儿童在 2 岁之前报告有喘息，26% 的儿童在 11 岁之前报告有持续性喘息。与白人儿童相比，（HR，1.47；95% CI，1.26-1.73）和西班牙裔儿童（HR，1.29；95% CI，1.09-1.53）哮喘发病风险显着增加，且出生在低收入家庭、人口密度和贫困地区的儿童哮喘发病率较高。分析表明，人口普查变量并没有显着改变种族和民族与哮喘发病风险之间的关联；与不同人口普查区社会经济水平的白人儿童相比，黑人和西班牙裔儿童患哮喘的风险仍然较高。结论和相关性调整个人层面的特征后，我们观察到，在所有收入水平的社区中，黑人和西班牙裔儿童患哮喘的比例更高。被视为呼吸系统健康不平等的根源。
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.