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Predictors of Pediatric Asthma Management: Identifying Actionable Results With Geographic Determinants
Enbal Shacham1,2, Stephen E Scroggins1,2, Adam Gilmore1,2
1Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri (Drs Shacham and Scroggins and Mr Gilmore); and Inland Empire Health Plan Rancho Cucamonga, California (Mss Cheng and Nava).
Insights
Proximity to industrial sites, major roads, and poor air quality significantly increase pediatric asthma exacerbations, especially in public housing. These factors are key for prioritizing environmental interventions and housing remediation resources.
Area of Science:
- Environmental Health
- Pediatric Pulmonology
- Geospatial Epidemiology
Background:
- Pediatric asthma is a major chronic condition in US youth.
- Geographic factors, including air pollutants, influence asthma development and exacerbations.
- Identifying geospatial predictors is crucial for managing pediatric asthma.
Purpose of the Study:
- To determine geospatial predictors of pediatric asthma exacerbation events.
- To prioritize housing remediation resources based on environmental risk factors.
- To understand the relationship between residential proximity to pollution sources and asthma severity.
Main Methods:
- Analysis of electronic medical records for 51,557 pediatric members (≤21 years) with asthma encounters (2019-2021).
- Inclusion of diagnoses, visit frequency, home addresses, air quality index, and proximity to roadways and manufacturing sites.
- Spatial analysis to identify significant geospatial predictors of asthma exacerbations.
Main Results:
- Individuals in public housing with more asthma visits lived closer to manufacturing sites (P < .001) and major roadways (P < .001).
- Higher numbers of poor air quality days were also associated with increased asthma visits (P < .001).
- These geospatial factors significantly predicted increased asthma-related healthcare encounters.
Conclusions:
- Findings confirm links between asthma, poor air quality, and proximity to industrial/transportation hubs.
- Public housing residents face compounded risks from nearby roadways and manufacturing sites.
- Research informs environmental interventions, housing inspections, and community outreach to mitigate asthma burdens.
Background:
Pediatric asthma remains one of the most prominent chronic health conditions among US youth. Geographic determinants such as air pollutants have been identified as playing a role in asthma development and exacerbation. The purpose of this study was to determine geospatial predictors of pediatric asthma exacerbation events and to prioritize housing remediation resources.
Methods:
Electronic medical records were abstracted from a health plan in Southern California. The inclusion criteria that created a sample of 51 557 members were those aged 21 years and younger, who had at least 1 asthma-related encounter between January 2019 and December 2021. Diagnoses, age, number of clinic and emergency department visits, and home addresses were included. The air quality index from the closest monitoring station during the study period, residential distance from a primary roadway, and residential distance from manufacturing sites were included in the spatial analysis.
Results:
The average number of asthma-related clinic visits was 2 across the sample. Individuals with more asthma-related clinic visits residing in public housing were more likely to live within 4 km of industrial manufacturing locations ( P < .001), reside closer to a major roadway ( P < .001), and experience a higher number of poor air quality days ( P < .001). Modeling results show these factors were also significantly predictive of an increase of asthma-related health care encounters.
Conclusions:
The findings of this study were consistent with previous studies linking asthma and poor air quality and further highlighted some of the additive and potentially exponential challenges that public housing, major roadways, and manufacturing sites provide communities in their proximity. This research can guide environmental interventions, including the frequency of public housing inspections, community outreach, and the development of communication strategies, to reduce asthma-related experiences across neighborhoods.
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