Sheffield PE, Shmool JLC, Kinnee EJ, Clougherty JE. Violent crime and socioeconomic deprivation in shaping asthma-related pollution susceptibility: a case-crossover design.
J Epidemiol Community Health 2019;
73:846-853. [PMID:
31289119 PMCID:
PMC6820152 DOI:
10.1136/jech-2018-211816]
[Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 05/23/2019] [Accepted: 06/06/2019] [Indexed: 11/04/2022]
Abstract
Background
The objective of this study was to quantify and compare the relative influence of community violent crime and socioeconomic deprivation in modifying associations between ozone and emergency department (ED) visits for asthma among children.
Methods
We used a spatiotemporal case-crossover analysis for all New York City EDs for the months May–September from 2005 to 2011 from a statewide administrative ED dataset. The data included 11 719 asthmatic children aged 5–18 years, and the main outcome measure was percentage of excess risk of asthma ED visit based on Cox regression analysis.
Results
Stronger ozone–asthma associations were observed for both elevated crime and deprivation (eg, on lag day 2, we found 20.0% (95% CI 10.2% to 30.6 %) and 21.0% (10.5% to 32.5%) increased risk per 10 ppb ozone, for communities in the highest vs lowest quartiles of violent crime and deprivation, respectively). However, in varied models accounting for both modifiers, only violence retained significance.
Conclusions
The results suggest stronger spatiotemporal ozone–asthma associations in communities of higher violent crime or deprivation. Notably, violence was the more consistent and significant modifier, potentially mediating a substantial portion of socioeconomic position–related susceptibility.
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