Understanding racial disparities in childhood asthma using individual- and neighborhood-level risk factors

Background: Racial disparities in childhood asthma outcomes result from a complex interplay of individual- and neighborhood-level factors. Objectives: We sought to examine racial disparities in asthma-related emergency department (ED) visits between African American (AA) and European American (EA) children. Methods: This is a retrospective study of patients younger than 18 years who visited the ED at Cincinnati Children's for asthma from 2009 to 2018. The outcome was number of ED visits during a year. We assessed 11 social, economic, and environmental variables. Mediation and mixed-effects analyses were used to assess relationships between race, mediators, and number of ED visits. Results: A total of 31,114 children (46.1% AA, 53.9% EA) had 186,779 asthma-related ED visits. AA children had more visits per year than EA children (2.23 vs 2.15; P < .001). Medicaid insurance was associated with a 7% increase in rate of ED visits compared with commercial insurance (1.07; 95% CI, 1.03-1.1). Neighborhood socioeconomic deprivation was associated with an increased rate of ED visits in AA but not in EA children. Area-level particulate matter with diameter less than 2.5 mu m, pollen, and outdoor mold were associated with an increased rate of ED visits for both AA and EA children (all P < .001). Associations between race and number of ED visits were mediated by insurance, area-level deprivation, particulate matter with diameter less than 2.5 mm, and outdoor mold (all P < .001), altogether accounting for 55% of the effect of race on ED visits. Race was not associated with number of ED visits (P = .796) after accounting for mediators. Conclusions: Racial disparities in asthma-related ED visits are mediated by social, economic, and environmental factors, which may be amenable to interventions aimed at improving outcomes and eliminating inequities.

Automated summary

Racial disparities exist in asthma-related emergency department visits among children, and these disparities are influenced by social, economic, and environmental factors. Insurance, neighborhood socioeconomic deprivation, particulate matter, and outdoor mold mediate the impact of race on emergency department visits.