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Titus AR, Terlizzi K, Conderino S, Ðoàn LN, Kim B, Thorpe LE. Patterns and drivers of disparities in pediatric asthma outcomes among Medicaid-enrolled children living in subsidized housing in NYC. Prev Med 2024; 185:108023. [PMID: 38908569 DOI: 10.1016/j.ypmed.2024.108023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/13/2024] [Accepted: 05/29/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE There are persistent disparities in pediatric asthma morbidity in the U.S. We linked claims data with information on neighborhood-level risk factors to explore drivers of asthma disparities among Medicaid-enrolled children in New York City subsidized housing. METHODS We constructed a cohort of Medicaid-enrolled children living in public or other subsidized housing, based on residential address, in NYC between 2016 and 2019 (n = 108,969). We examined claims-derived asthma prevalence across age and racial and ethnic groups, integrating census tract-level information and using the Bayesian Improved Surname Geocoding (BISG) algorithm to address high rates of missing data in self-reported race and ethnicity. We used inverse probability weighting (IPW) to explore the extent to which disparities persisted when exposure to asthma risk factors - related to the built environment, neighborhood poverty, and air quality - were balanced across groups. This analysis was conducted in 2022-2023. RESULTS Claims-derived asthma prevalence was highest among children <7 years at baseline and among non-Hispanic Black and Hispanic children. For example, among children aged 3-6 years at baseline, claims-derived prevalence was 17.3% and 18.1% among non-Hispanic Black and Hispanic children, respectively, compared to 9.3% and 9.0% among non-Hispanic White and non-Hispanic Asian American/Pacific Islander children. Using IPW to balance exposure to asthma risk factors across racial and ethnic groups attenuated, but did not eliminate, disparities in asthma prevalence. CONCLUSIONS We found high asthma burden among children living in subsidized housing. Modifiable place-based characteristics may be important contributors to pediatric asthma disparities.
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Affiliation(s)
- Andrea R Titus
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America.
| | - Kelly Terlizzi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Sarah Conderino
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Lan N Ðoàn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Byoungjun Kim
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Lorna E Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
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2
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Khan RN, Saporito AF, Zenon J, Goodman L, Zelikoff JT. Traffic-related air pollution in marginalized neighborhoods: a community perspective. Inhal Toxicol 2024; 36:343-354. [PMID: 38618680 DOI: 10.1080/08958378.2024.2331259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/10/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES Marginalized communities are exposed to higher levels of traffic-related air pollution (TRAP) than the general population. TRAP exposure is linked to pulmonary toxicity, neurotoxicity, and cardiovascular toxicity often through mechanisms of inflammation and oxidative stress. Early life exposure to TRAP is also implicated in higher rates of asthma in these same communities. There is a critical need for additional epidemiological, in vivo, and in vitro studies to define the health risks of TRAP exposure affecting the most vulnerable groups to set strict, protective air pollution standards in these communities. MATERIALS AND METHODS A literature review was conducted to summarize recent findings (2010-2024) concerning TRAP exposure and toxic mechanisms that are relevant to the most affected underserved communities. CONCLUSIONS Guided by the perspectives of NYC community scientists, this contemporary review of toxicological and epidemiological studies considers how the exposome could lead to disproportionate exposures and health effects in underserved populations.
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Affiliation(s)
- Rahanna N Khan
- Division of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Antonio F Saporito
- Division of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Jania Zenon
- Division of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Judith T Zelikoff
- Division of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
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3
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Domingo KN, Gabaldon KL, Hussari MN, Yap JM, Valmadrid LC, Robinson K, Leibel S. Impact of climate change on paediatric respiratory health: pollutants and aeroallergens. Eur Respir Rev 2024; 33:230249. [PMID: 39009406 PMCID: PMC11262702 DOI: 10.1183/16000617.0249-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/07/2024] [Indexed: 07/17/2024] Open
Abstract
Paediatric populations are particularly vulnerable to respiratory diseases caused and exacerbated by aeroallergens, pollutants and infectious agents. Worsening climate change is expected to increase the prevalence of pollutants and aeroallergens while amplifying disease severity and causing disproportionate effects in under-resourced areas. The purpose of this narrative review is to summarise the role of anthropogenic climate change in the literature examining the future impact of aeroallergens, pollutants and infectious agents on paediatric respiratory diseases with a focus on equitable disease mitigation. The aeroallergens selected for discussion include pollen, dust mites and mould as these are prevalent triggers of paediatric asthma worldwide. Human rhinovirus and respiratory syncytial virus are key viruses interacting with climate change and pollution and are primary causal agents of viral respiratory disease. Within this review, we present the propensity for aeroallergens, climate change and pollution to synergistically exacerbate paediatric respiratory disease and outline measures that can ameliorate the expected increase in morbidity and severity of disease through a health equity lens. We support shifting from fossil fuels to renewable energy worldwide, across sectors, as a primary means of reducing increases in morbidity.
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Affiliation(s)
- Karyssa N Domingo
- School of Medicine, University of California San Diego, La Jolla, CA, USA
- K.N. Domingo and K.L. Gabaldon contributed equally
| | - Kiersten L Gabaldon
- School of Medicine, University of California San Diego, La Jolla, CA, USA
- K.N. Domingo and K.L. Gabaldon contributed equally
| | | | - Jazmyn M Yap
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | - Kelly Robinson
- Department of Pediatrics, Division of Allergy and Immunology, University of California San Diego, La Jolla, CA, USA
| | - Sydney Leibel
- Department of Pediatrics, Division of Allergy and Immunology, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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4
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Rogerson CM, Hogan AH, Waldo B, White BR, Carroll CL, Shein SL. Wide Institutional Variability in the Treatment of Pediatric Critical Asthma: A Multicenter Retrospective Study. Pediatr Crit Care Med 2024; 25:37-46. [PMID: 37615529 DOI: 10.1097/pcc.0000000000003347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Children with status asthmaticus refractory to first-line therapies of systemic corticosteroids and inhaled beta-agonists often receive additional treatments. Because there are no national guidelines on the use of asthma therapies in the PICU, we sought to evaluate institutional variability in the use of adjunctive asthma treatments and associations with length of stay (LOS) and PICU use. DESIGN Multicenter retrospective cohort study. SETTING Administrative data from the Pediatric Health Information Systems (PHIS) database. PATIENTS All inpatients 2-18 years old were admitted to a PHIS hospital between 2013 and 2021 with a diagnostic code for asthma. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS This study included 213,506 inpatient encounters for asthma, of which 29,026 patient encounters included care in a PICU from 39 institutions. Among these PICU encounters, large variability was seen across institutions in both the number of adjunctive asthma therapies used per encounter (min: 0.6, median: 1.7, max: 2.5, p < 0.01) and types of adjunctive asthma therapies (aminophylline, ipratropium, magnesium, epinephrine, and terbutaline) used. The center-level median hospital LOS ranged from 1 (interquartile range [IQR]: 1, 3) to 4 (3, 6) days. Among all the 213,506 inpatient encounters for asthma, the range of asthma admissions that resulted in PICU admission varied between centers from 5.2% to 47.3%. The average number of adjunctive therapies used per institution was not significantly associated with hospital LOS ( p = 0.81) nor the percentage of encounters with PICU admission ( p = 0.47). CONCLUSIONS Use of adjunctive therapies for status asthmaticus varies widely among large children's hospitals and was not associated with hospital LOS or the percentage of encounters with PICU admission. Wide variance presents an opportunity for standardizing care with evidence-based guidelines to optimize outcomes and decrease adverse treatment effects and hospital costs.
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Affiliation(s)
- Colin M Rogerson
- Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Alexander H Hogan
- Division of Hospital Medicine, Connecticut Children's Medical Center, Hartford, CT
| | - Briana Waldo
- Department of Respiratory Therapy, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Benjamin R White
- Division of Pediatric Critical Care Medicine, University of Utah, Salt Lake City, UT
| | - Christopher L Carroll
- Department of Pediatrics, Wolfson Children's, University of Florida, Jacksonville, FL
| | - Steven L Shein
- Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH
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5
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Kumar A, Zhang S, Neshteruk CD, Day SE, Konty KJ, Armstrong S, Skinner AC, Lang JE, D'Agostino EM. The longitudinal association between asthma severity and physical fitness by neighborhood factors among New York City public school youth. Ann Epidemiol 2023; 88:37-42. [PMID: 37944678 DOI: 10.1016/j.annepidem.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/28/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE This paper aims to examine the association between asthma severity and one-year lagged fitness in New York City Public school youth by neighborhood opportunity. METHODS Using the Child Opportunity Index 2.0 and individual-level repeated measures NYC Office of School Health (OSH) fitness surveillance data (2010-2018), we ran multilevel mixed models stratified by neighborhood opportunity, adjusting for sex, race/ethnicity, grade level, poverty status, and time. Asthma severity was based on a physician-completed Asthma Medication Administration Form (MAF) from each school year and drawn from the Automated Student Health Record (ASHR). RESULTS Across all youth in grades 4-12 (n = 939,598; 51.7 % male; 29.9 % non-Hispanic Black, 39.3 % Hispanic; 70.0 % high poverty), lower neighborhood opportunity was associated with lower subsequent fitness. Youth with severe asthma and very low and low neighborhood opportunity had the lowest 1-year lagged fitness z-scores - 0.24 (95 % CI, -0.34 to -0.14) and - 0.26 (95 % CI, -0.32 to -0.20), respectively, relative to youth with no asthma and very high opportunity. CONCLUSIONS An inverse longitudinal relationship between asthma severity and subsequent fitness was observed. Study findings have implications for public health practitioners to promote physical activity and improved health equity for youth with asthma, taking neighborhood factors into account.
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Affiliation(s)
- Advika Kumar
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Sue Zhang
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Cody D Neshteruk
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, USA
| | - Sophia E Day
- New York City Department of Health and Mental Hygiene, Office of School Health, New York, NY, USA
| | - Kevin J Konty
- New York City Department of Health and Mental Hygiene, Office of School Health, New York, NY, USA
| | - Sarah Armstrong
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Pediatrics, Duke University Medical School, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA
| | - Asheley C Skinner
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Jason E Lang
- Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Pediatrics, Duke University Medical School, Durham, NC, USA
| | - Emily M D'Agostino
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Orthopaedic Surgery, Duke University Medical School, Durham, NC, USA.
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6
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Waters EA, Pachur T, Pogge G, Hunleth J, Webster GD, Fedele DA, Shepperd JA. How are mental representations of asthma triggers and symptoms related to interpersonal risk perceptions? A psychometric investigation of caregivers of children with asthma. Psychol Health 2023:1-23. [PMID: 37545105 PMCID: PMC11073392 DOI: 10.1080/08870446.2023.2244522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Parents and guardians (hereafter caregivers) make decisions for their children's medical care. However, many caregivers of children with asthma struggle to understand their child's illness. We used the psychometric paradigm to investigate how caregivers conceptualize, or mentally represent, asthma triggers and symptoms and how these representations are linked to perceived asthma exacerbation risk. METHODS We asked 377 caregivers of children with asthma across the U.S. to rate 20 triggers or 20 symptoms along 15 characteristics. Caregivers also indicated their perceived risk of their child having an asthma exacerbation (hereafter interpersonal risk perceptions). Using principal components analysis, we extracted key dimensions underlying caregivers' ratings on the characteristics. Then we related the triggers' and symptoms' scores on the dimensions to caregivers' interpersonal risk perceptions. RESULTS Interpersonal risk perceptions were higher for triggers with high ratings for the dimensions severe and relevant, and negative affect-yet manageable, but not chronic-yet unpredictable. Risk perceptions were also higher for symptoms with high ratings for the dimensions severe and unpredictable, and relevant and common, but not self-blame or manageable despite unknown cause. CONCLUSION By identifying key dimensions underlying caregivers' mental representations of asthma triggers and symptoms, these findings can inform a new approach to asthma education.
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Affiliation(s)
- Erika A. Waters
- Washington University in St. Louis, Saint Louis, Missouri, USA
| | | | | | - Jean Hunleth
- Washington University in St. Louis, Saint Louis, Missouri, USA
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Bhandari R, Armenian SH. Risk of Frailty in Survivors of Childhood Cancer: The Role of Socioenvironmental Factors. Cancer Epidemiol Biomarkers Prev 2023; 32:997-998. [PMID: 37525968 DOI: 10.1158/1055-9965.epi-23-0642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 08/02/2023] Open
Abstract
The identification of frailty among relatively young survivors of childhood cancer has led to a growing body of work aimed at examining potential risk factors and interventions to decrease its burden in this population. In the accompanying article, Schwartz and colleagues present their findings regarding the association between neighborhood characteristics and frailty in survivors of childhood cancer and show that survivors living in resource poor neighborhoods had increased odds of frailty compared with those in resource-rich neighborhoods. This work further supports the need for focused educational initiatives and nutrition and exercise interventions to improve survivors' quality of health. See related article by Schwartz et al., p. 1021.
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Affiliation(s)
- Rusha Bhandari
- Department of Pediatrics, City of Hope, Duarte, California
- Department of Population Sciences, City of Hope, Duarte, California
| | - Saro H Armenian
- Department of Pediatrics, City of Hope, Duarte, California
- Department of Population Sciences, City of Hope, Duarte, California
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8
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McDermott-Levy R, Pennea E, Moore C. Protecting Children's Health: Asthma and Climate Change. MCN Am J Matern Child Nurs 2023; 48:188-194. [PMID: 36943899 DOI: 10.1097/nmc.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
ABSTRACT Children are particularly vulnerable to the impacts of climate change. Their lungs are developing, making children with asthma especially susceptible to temperature extremes, variations in precipitation, poor air quality, and changes in pollen and flora. Structural and social determinants of health, such as racism and poverty, that disproportionately affect children of color are linked to higher rates of asthma and negative effects of climate change. These factors lead to increased absences from school and social activities, loss of work for caregivers, and increased health care costs, thus negatively affecting children, their families, and the greater community. Nurses must support caregivers and children to link climate change to asthma care, be involved in health education; climate change mitigation and adaptation strategies and policies; and develop the evidence to address climate change and asthma strategies. We address the impacts of climate change on children with asthma and nursing adaptation responses.
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9
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Bhandari R, Teh JB, He T, Nakamura R, Artz AS, Jankowska MM, Forman SJ, Wong FL, Armenian SH. Social Vulnerability and Risk of Nonrelapse Mortality After Allogeneic Hematopoietic Cell Transplantation. J Natl Cancer Inst 2022; 114:1484-1491. [PMID: 35980163 PMCID: PMC9664181 DOI: 10.1093/jnci/djac150] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/27/2022] [Accepted: 07/06/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Risk of nonrelapse mortality (NRM) after hematopoietic cell transplantation (HCT) is high. Patient-level clinical prediction models such as the HCT-comorbidity index (HCT-CI) help identify those at increased risk for NRM, but the independent contribution of social determinants of health on HCT outcomes is not well characterized. METHODS This study included 1602 patients who underwent allogeneic HCT between 2013 and 2019 at City of Hope. Census tract-level social vulnerability was measured using the social vulnerability index (SVI). Fine-Gray multivariable regression evaluated the association between SVI and 1-year NRM. Subgroup analysis examined risk of NRM across combined SVI and HCT-CI categories and by race and ethnicity. RESULTS Cumulative incidence of 1-year NRM after HCT was 15.3% (95% confidence interval [CI] = 13.6% to 17.1%). In multivariable analysis, patients in the highest SVI tertile (highest social vulnerability) had a 1.4-fold risk (subdistribution hazard ratio [sHR] = 1.36, 95% CI = 1.04 to 1.78) of NRM compared with individuals in the lower tertiles; patients in the highest SVI tertile who also had elevated (≥3) HCT-CI scores had the highest risk (sHR = 1.81, 95% CI = 1.26 to 2.58) of 1-year NRM (reference: lower SVI tertiles and HCT-CI < 3). High social vulnerability was associated with risk of 1-year NRM in Asian (sHR = 2.03, 95% CI = 1.09 to 3.78) and Hispanic (sHR = 1.63, 95% CI = 1.04 to 2.55) but not non-Hispanic White patients. CONCLUSIONS High social vulnerability independently associated with 1-year NRM after HCT, specifically among minority populations and those with a high comorbidity burden at HCT. These findings may inform targeted approaches for needs assessment during and after HCT, allowing for timely interventions to improve health outcomes in at-risk patients.
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Affiliation(s)
- Rusha Bhandari
- Department of Pediatrics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jennifer Berano Teh
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- Current affiliation: The Heart Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Tianhui He
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Andrew S Artz
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Marta M Jankowska
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Stephen J Forman
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - F Lennie Wong
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Saro H Armenian
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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Hwa Jung K, Pitkowsky Z, Argenio K, Quinn JW, Bruzzese JM, Miller RL, Chillrud SN, Perzanowski M, Stingone JA, Lovinsky-Desir S. The effects of the historical practice of residential redlining in the United States on recent temporal trends of air pollution near New York City schools. ENVIRONMENT INTERNATIONAL 2022; 169:107551. [PMID: 36183489 PMCID: PMC9616211 DOI: 10.1016/j.envint.2022.107551] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In the 1930's the United States (US) sponsored Home Owners' Loan Corporation (HOLC) created maps that determined risk for mortgage lending based on the racial and ethnic composition of neighborhoods leading to disinvestment in "redlined" or highest risk neighborhoods. This historical practice has perpetuated racial and economic segregation, and health disparities, that persist today. Interventions near schools where children spend large portions of the day, could impact large groups of children but schools are an often-overlooked environment for exposure. Despite a declining trend of ambient pollution in New York City (NYC) between 1998 and 2012, little is known about differences in air quality improvement near schools by historical redlining neighborhood status. Our objective was to examine if recent temporal trends of air pollution near NYC public schools differed in historically redlined neighborhoods. METHODS We examined annual average street-level concentrations of combustion-related air pollutants (black carbon (BC), particulate matter (PM2.5), nitrogen dioxide (NO2), and nitric oxide (NO)), within a 250-m radius around schools using NYC Community Air Survey land-use regression models (n = 1,462). Year of monitoring, historical redlining (binary), and summer ozone were included in multivariable linear regression using generalized estimating equation models. Average annual percent change (APC) in pollutant concentration was calculated. Models were further stratified by historical redlining and a multiplicative interaction term (year of monitoring × historical redlining) was used to assess effect modification. RESULTS Overall, there was a decreasing trend of BC (APC = -4.40%), PM2.5 (-3.92%), NO2 (-2.76%), and NO (-6.20%) during the 10-year period. A smaller reduction of BC, PM2.5 and NO was observed in redlined neighborhoods (n = 722), compared to others (n = 740): BC (APC: -4.11% vs -4.69%; Pinteraction < 0.01), PM2.5 (-3.82% vs -4.11%; Pinteraction < 0.01), and NO (-5.73% vs -6.67%; Pinteraction < 0.01). Temporal trends of NO2 did not differ by historical redlining (Pinteraction = 0.60). CONCLUSIONS Despite significant reductions in annual average pollution concentrations across NYC, schools in historically redlined neighborhoods, compared to others, experienced smaller decrease in pollution, highlighting a potential ongoing ramification of the discriminatory practice.
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Affiliation(s)
- Kyung Hwa Jung
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 3959 Broadway CHC-745, New York, NY 10032, United States.
| | - Zachary Pitkowsky
- Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, United States.
| | - Kira Argenio
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 3959 Broadway CHC-745, New York, NY 10032, United States.
| | - James W Quinn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168 St., New York, NY 10032, United States.
| | - Jean-Marie Bruzzese
- Columbia University School of Nursing, 560 W. 168 St., New York, NY 10032, United States.
| | - Rachel L Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, United States.
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory of Columbia University, 61 Rt 9W, Palisades, NY 10964, United States.
| | - Matthew Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168 St., New York, NY 10032, United States.
| | - Jeanette A Stingone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168 St., New York, NY 10032, United States.
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 3959 Broadway CHC-745, New York, NY 10032, United States.
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11
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Kim B, Mulready-Ward C, Thorpe LE, Titus AR. Housing environments and asthma outcomes within population-based samples of adults and children in NYC. Prev Med 2022; 161:107147. [PMID: 35803352 DOI: 10.1016/j.ypmed.2022.107147] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/02/2022] [Accepted: 07/03/2022] [Indexed: 01/14/2023]
Abstract
Exposure to indoor environmental risk factors is associated with patterns of asthma morbidity. In this study, we assessed the relationship between housing type (i.e., home ownership, public housing, rental assistance, rent-controlled housing and other rental housing) and asthma outcomes among New York City (NYC) adults and children (ages 1-13). We used the 2019 NYC Community Health Survey (CHS) and 2019 NYC KIDS survey to analyze associations between housing type and ever having been diagnosed with asthma ("ever asthma") and experiencing a past-year asthma attack. We further examined whether associations were modified by smoking status (among adults), smoking within the home (among children), and overweight/obesity. Among adults, living in public housing, compared to home ownership, was associated with higher odds of ever asthma (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.35, 2.84), and past-year asthma attack (OR = 2.24; 95% CI 1.21,4.18). Living in rental assistance housing was also significantly associated with ever asthma (OR = 1.75; 95% CI 1.16, 2.66). Associations between public or rental assistance housing and ever asthma were marginally non-significant among children. Associations between living in public or rental assistance housing and ever asthma were more pronounced among ever smokers than among never smokers. Housing environments remain important predictors of both pediatric and adult asthma morbidity. Associations between living in subsidized housing and asthma outcomes among adults are most apparent among ever smokers.
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Affiliation(s)
- Byoungjun Kim
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States; Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Candace Mulready-Ward
- New York City Department of Health and Mental Hygiene, Long Island City, NY, United States
| | - Lorna E Thorpe
- Department of Population Health, New York University School of Medicine, New York, NY, United States
| | - Andrea R Titus
- Department of Population Health, New York University School of Medicine, New York, NY, United States.
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12
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Bozigar M, Connolly CL, Legler A, Adams WG, Milando CW, Reynolds DB, Carnes F, Jimenez RB, Peer K, Vermeer K, Levy JI, Fabian MP. In-home environmental exposures predicted from geospatial characteristics of the built environment and electronic health records of children with asthma. Ann Epidemiol 2022; 73:38-47. [PMID: 35779709 DOI: 10.1016/j.annepidem.2022.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/03/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Children may be exposed to numerous in-home environmental exposures (IHEE) that trigger asthma exacerbations. Spatially linking social and environmental exposures to electronic health records (EHR) can aid exposure assessment, epidemiology, and clinical treatment, but EHR data on exposures are missing for many children with asthma. To address the issue, we predicted presence of indoor asthma trigger allergens, and estimated effects of their key geospatial predictors. METHODS Our study samples were comprised of children with asthma who provided self-reported IHEE data in EHR at a safety-net hospital in New England during 2004-2015. We used an ensemble machine learning algorithm and 86 multilevel features (e.g., individual, housing, neighborhood) to predict presence of cockroaches, rodents (mice or rats), mold, and bedroom carpeting/rugs in homes. We reduced dimensionality via elastic net regression and estimated effects by the G-computation causal inference method. RESULTS Our models reasonably predicted presence of cockroaches (area under receiver operating curves [AUC] = 0.65), rodents (AUC = 0.64), and bedroom carpeting/rugs (AUC = 0.64), but not mold (AUC = 0.54). In models adjusted for confounders, higher average household sizes in census tracts were associated with more reports of pests (cockroaches and rodents). Tax-exempt parcels were associated with more reports of cockroaches in homes. Living in a White-segregated neighborhood was linked with lower reported rodent presence, and mixed residential/commercial housing and newer buildings were associated with more reports of bedroom carpeting/rugs in bedrooms. CONCLUSIONS We innovatively applied a machine learning and causal inference mixture methodology to detail IHEE among children with asthma using EHR and geospatial data, which could have wide applicability and utility.
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Affiliation(s)
- Matthew Bozigar
- Department of Environmental Health, Boston University School of Public Health, Boston, MA.
| | - Catherine L Connolly
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | | | - William G Adams
- Department of Pediatrics, Boston Medical Center/Boston University School of Medicine, Boston, MA; Biomedical Informatics Core, Boston University Clinical and Translational Science Institute, Boston University School of Medicine, Boston, MA
| | - Chad W Milando
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - David B Reynolds
- Mathematics and Statistics Department, Boston University Arts and Sciences, Boston, MA
| | - Fei Carnes
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Raquel B Jimenez
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Komal Peer
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | | | - Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Maria Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
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13
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Evidence of the Relationship between Social Vulnerability and the Spread of COVID-19 in Urban Spaces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095336. [PMID: 35564729 PMCID: PMC9104638 DOI: 10.3390/ijerph19095336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/21/2022] [Accepted: 04/23/2022] [Indexed: 02/04/2023]
Abstract
Modeling the social-spatial structure of urban spaces can facilitate the development of guidelines aimed at curbing the spread of the COVID-19 pandemic while also acting as an instrument that helps decision-making concerning mitigation policies. The modeling process starts with categorization of urban spaces based on the concept of social vulnerability. A model is created based on this concept and the theory of analysis of social areas. Statistical techniques of factor analysis and geostatistics are applied. This generates a map of social differentiation that, when related to data on the evolution of the contagion, generates a multidimensional model of social vulnerability. The application of this model towards people (social structure) and the environment where they live (spatial structure) is specified. Our model assumes the uniqueness of cities, and it is intended to be a broadly applicable model that can be extrapolated to other urban areas if pertinent revisions are made. Our work demonstrates that aspects of the social and urban structures may be validly used to analyze and explain the spatial spread of COVID-19.
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14
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Effect Evaluation of Electronic Health PDCA Nursing in Treatment of Childhood Asthma with Artificial Intelligence. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2005196. [PMID: 35388323 PMCID: PMC8979696 DOI: 10.1155/2022/2005196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 01/18/2023]
Abstract
Asthma in children has a long duration and is prone to recurring attacks. Children will feel chest tightness, shortness of breath, cough, and difficulty breathing when they are onset, which has a serious impact on their health. Clinical nursing is of great significance in the treatment of childhood asthma. At present, the electronic health PDCA nursing model is widely used in clinical nursing as a common and effective nursing method. Therefore, it is very important to evaluate the efficacy of the PDCA nursing model in the treatment of childhood asthma. With the development of artificial intelligence, artificial intelligence can be used to evaluate the effect of the PDCA nursing model in the treatment of childhood asthma. The BP network can effectively perform data training and discrimination, but its training efficiency is low, and it is easily affected by initial weights and thresholds. Aiming at this defect, this work uses the genetic simulated annealing (GSA) algorithm to improve it. In view of the problems that the genetic algorithm falls into local minimum and simulated annealing algorithm has a slow convergence speed, the improved genetic simulated annealing algorithm is used to optimize the BP neural network, and an improved genetic simulated annealing BP network (IGSA-BP) is proposed. The algorithm not only reduces the problem that the BP network has an influence on initial weight and threshold on the algorithm but also improves the population diversity and avoids falling into local optimum by improving the crossover and mutation probability formula and improving Metropolis criterion. The proposed method has more efficient performance.
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15
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Calvo M, Kelman E, Gould LH, Gwynn RC, Bates LM, Davila M, Gany F, Huynh M, Siscovick D. Health Data for New York City Overview: Advancing Health Equity through Policy-Relevant Collaborative Research. J Urban Health 2021; 98:695-699. [PMID: 34799822 PMCID: PMC8604197 DOI: 10.1007/s11524-021-00587-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Michele Calvo
- New York Academy of Medicine, New York City, NY, USA.
| | - Elizabeth Kelman
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - L Hannah Gould
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - R Charon Gwynn
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Lisa M Bates
- Columbia University Mailman School of Public Health, New York City, USA
| | - Marivel Davila
- Center for Health Equity and Community Wellness, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Francesca Gany
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Weill Cornell Medical College, New York City, NY, USA
| | - Mary Huynh
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York City, NY, USA
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