Areas with High Rates of Police-Reported Violent Crime Have Higher Rates of Childhood Asthma Morbidity

Abstract

To assess whether population-level violent (and all) crime rates were associated with population-level child asthma utilization rates and predictive of patient-level risk of asthma reutilization after a hospitalization. A retrospective cohort study of 4638 pediatric asthma-related emergency department visits and hospitalizations between 2011 and 2013 was completed. For population-level analyses, census tract asthma utilization rates were calculated by dividing the number of utilization events within a tract by the child population. For patient-level analyses, hospitalized patients (n=981) were followed until time of first asthma-related reutilization. The primary predictor was the census tract rate of violent crime as recorded by the police; the all crime (violent plus nonviolent) rate was also assessed. Census tract-level violent and all crime rates were significantly correlated with asthma utilization rates (both P<.0001). The violent crime rate explained 35% of the population-level asthma utilization variance and remained associated with increased utilization after adjustment for census tract poverty, unemployment, substandard housing, and traffic exposure (P=.002). The all crime rate explained 28% of the variance and was similarly associated with increased utilization after adjustment (P=.02). Hospitalized children trended toward being more likely to reutilize if they lived in higher violent (P=.1) and all crime areas (P=.01). After adjustment, neither relationship was significant. Crime data could help facilitate early identification of potentially toxic stressors relevant to the control of asthma for populations and patients.