Pediatrics Resident Emory University School of Medicine Atlanta, Georgia, United States
Background: A large body of evidence demonstrates the impact environment has on the development of childhood asthma and its outcomes. It is well described that inequities in asthma outcomes exist on the basis of race, socioeconomic status, and urban living. There is also growing research describing environmental inequities impacting asthma outcomes. However, more research is needed regarding the cumulative impact of both social and environmental factors on childhood asthma. The Environmental Justice Index (EJI) is a new validated tool from CDC that ranks each U.S. Census tract based on environmental, social, and health factors. This innovative tool has yet to be applied to a pediatric population. Objective: The objective of the study is to evaluate whether the EJI and its subcomponents are associated with increased risk for asthma exacerbation. We hypothesize that neighborhood-level social and environmental factors are associated with increased risk for asthma exacerbation in urban pediatric populations. Design/Methods: The study has been approved by Children's Healthcare of Atlanta IRB. The study population is pediatric patients > 2 years of age with a primary diagnosis of asthma. The index setting includes pulmonology, allergy, and primary care clinics at a large tertiary care pediatric health system in Atlanta, Georgia. A data query identified 39,444 index visits. In the 90-day period following the index visit, hospitalizations, emergency department visits, and oral steroid prescriptions for asthma were noted. Covariates include age, clinic specialty, asthma severity, sex, race, insurance status, and BMI category. Addresses were gathered from identified patients and geocoded to obtain census tract. We are expanding the query to include EJI and its environmental subcomponents, specifically air pollution, toxic sites, built environment, transportation, and water pollution. We will use a mixed effect regression analysis to assess whether a patient’s risk of exacerbation is associated with EJI and its subcomponents. We will complete this project within the next 3 months.
