Izzuddin M. Aris, PhD

Credit: Harvard Medical School

Residence in neighborhoods known to have high opportunity for early life—termed ‘greater neighborhood opportunity’—is associated with diminished incidence of childhood asthma, according to recent findings.¹

These recent findings came from a new study which was conducted with the purpose of examining potential links between measures of neighborhood-level opportunities for individuals and vulnerability in childrens’ early lives to incidence of asthma, given the lack of current research into such associations.²

While some research has been conducted on such a topic, most such studies were shown to have been cross-sectional or directed at single socioeconomic indicators that might not cover the entirety of early experiences for children. Consequently, this research was authored by Izzuddin M. Aris, PhD, from the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute.

“To address these research gaps, we analyzed data from racially, ethnically, and geographically diverse children enrolled in cohorts participating in the Environmental Influences on Child Health Outcomes (ECHO) Program…” Izzuddin and colleagues wrote. “We hypothesized that children residing in neighborhoods with higher (vs lower) opportunity or in less (vs more) vulnerable neighborhoods would have lower asthma incidence.”

Background and Findings

The investigators used data from children who were in the process of taking part in 46 different cohorts that had been examined from the Environmental Influences on Child Health Outcomes (ECHO) Program. This study by the investigators was known to have spanned from January of 1995 to August of 2022.

The research team’s tracking went on until the time of their diagnosis, the final meeting or loss to follow-up date, or when the study’s patients became 20 years of age. In order to be included in their research, the participants had to have a geocoded residential address from their birth in addition to a guardian’s report which confirmed a clinician’s diagnosis of the condition.

The team analyzed census tract–level Social Vulnerability Index (SVI) as well as Child Opportunity Index (COI) exposures at the time of their birth, infancy, or even their early childhood years. Such indexes were labeled as being in specified ranges: <20th percentile (very low), 20th to <40th percentile (low), 40th to <60th percentile (moderate), 60th to <80th percentile (high), or ≥80th percentile (very high) SVI or COI.

The investigators determined the primary outcome to be based upon reports from the caregivers of the participants, the contents of which demonstrated whether a clinician had diagnosed asthma in one’s childhood with a ‘yes or no’ questionnaire. The team also used Poisson regression models, assessing the participants’ asthma incidence rate ratios (IRRs) and linking them with COI/ SVI scores across different stages of patients’ lives.

The investigators enrolled 10,516 patients that had a median age of 9.1 years at follow-up. They reported that 52.2% of the individuals included in their research were found to be male, and 20.6% were shown to have resided in areas characterized by both very low SVI and by very high COI.

The research team also noted that the overall incidence rate for patients’ asthma stood at 23.3 cases per 1000 child-years, and they added that there was a median age of patient diagnosis at 6.6 years. The team reported that COI levels at the time of patients’ births, in their infancy, or in their early childhoods—labeled as high or very high as opposed to very low—showed links to a diminished subsequent incidence of asthma, independent of sociodemographic elements, parent history of the condition, and parity.

The team found that SVI at the time of participants’ early lives was shown not to be substantially connected to incidence. As an example, in comparison to a SVI labeled as very high, the adjusted IRR for the condition was shown to be 0.88 (95% CI, 0.75 - 1.02) for low SVI at the time of birth and 0.89 (95% CI, 0.76 - 1.03) for very low SVI at the time of birth.

The investigators noted that in comparison to very low COI, the adjusted incidence rate ratio (IRR) for the condition was shown to be 0.87 (95% CI, 0.75 - 1.00) for high COI at the time of birth and it was 0.83 (95% CI, 0.71 - 0.98) for very high COI at the time of birth. Such connections were potentially affected by the health and environmental as well as the social and economic dimensions of the COI.

“Our findings highlight the need for future studies examining whether investing in health and environmental or social and economic resources in early life promotes health equity in pediatric asthma,” they wrote.

References

1. ^{Aris IM, Perng W, Dabelea D, et al. Neighborhood Opportunity and Vulnerability and Incident Asthma Among Children. JAMA Pediatr. Published online August 28, 2023. doi:10.1001/jamapediatrics.2023.3133.}
2. ^{Daelmans B, Darmstadt GL, Lombardi J, et al; Lancet Early Childhood Development Series Steering Committee. Early childhood development: the foundation of sustainable development. Lancet. 2017;389(10064):9-11. doi:10.1016/S0140-6736(16)31659-2.}