Researchers Draw Association Between Asthma Rates, Urgent Care, and NYC Pollutants

A new study has found a differentiation between modeled street level pollutant levels and rates of urgent asthma care in communities with varying prevalence of asthma.

A group of New York-based researchers — led by Stephanie Lovinsky-Desir, MD (pictured) — from Columbia University Medical Center, Columbia Mailman School of Public Health, and the Lamont-Doherty Earth Observatory of Columbia conducted research into the associations between combustion-related air pollutant levels and urgent asthma care as differed by neighborhood asthma prevalence.

The study results were presented at the 2017 Annual CHEST Meeting in Toronto, ON, CA. It drew base data from the New York City Neighborhood Asthma and Allergy Study (NYCNAAS), an analysis of asthmatic children from middle-income families recruited through a single health insurance provider.

The NYCNAAS showed that children from neighborhoods with higher asthma prevalence (HAPN) made more urgent medical visits for their condition than those in neighborhoods with lower asthma prevalence (LAPN). However, there was no indicated difference in asthma severity.

“Exposure to combustion-related air pollutants has been associated with increased asthma prevalence, symptoms, and health care utilization, and is higher in HAPN than LAPN of NYC,” researchers wrote.

Researchers hypothesized that there would be greater associations between pollutant exposure and urgent medical visits in NYC children living in HAPN.

They NYCNAAS drew data from 190 children with asthma, aged 7 to 8. The split among patient population HAPN and LAPN was in the former’s favor (99 to 91). Researchers used participating children’s zip codes and home addresses to collect annual average pollution concentrations from the NYC Community Air Survey.

The collected pollutant elements included nitrogen dioxide (NO2), particulate matter (PM2.5) and elemental carbon (EC); summer average ozone (O3); and winter average sulfur dioxide (SO2).

Researchers used Modified Poisson regression models to determine the prevalence ratio (PR) of seeking urgent asthma care in the last year with consideration to high neighborhood pollutant levels. They controlled for sex, race, second-hand smoke, maternal asthma, parental income, preventive asthma medication, exercise-induced wheeze, residential building type, and neighborhood.

Results showed that concentrations of NO2, PM2.5, EC, and SO2 were significantly higher in HAPN than LAPN, while just O3 was higher in LAPN. Overall, NO2 and PM2.5 concentrations were associated with a greater prevalence of urgent asthma care.

Contrary to the researchers’ hypothesis, asthmatic children in LAPN were the only to report an association between pollutants and urgent asthma care. The lack of association for children in HAPN “highlights the influence of additional environmental and biological factors, aside from pollution, on health care utilization,” researchers wrote.

There was still concrete conclusion to draw from the collected data. Pollutant exposure, as modeled from pediatric patients’ street levels, proved a strong predictor of urgent asthma visits in LAPN.