Impoverished and historically marginalized communities often reside in areas with increased air pollution. To evaluate the association between EJ track, asthma severity and control as modified by TRAP. This is a retrospective study of 1526 adult asthma patients in Allegheny County, PA, enrolled in an asthma registry from 2007-2020. Asthma severity and control were determined using global guidelines. EJ tract designation was based on residency in census tracts with ≥30% non-white and/or ≥20% impoverished populations. TRAP exposures (NO2 and Black Carbon) for each census tract were normalized into quartiles of pollution. Generalized Linear Model (GLM) analyses determined the effect of EJ tract and TRAP on asthma. TRAP exposure in the highest quartile range was more frequent among patients living in an EJ tract (66.4% vs.20.8%, p<.05). Living in an EJ tract increased the odds of severe asthma in later onset asthma. The odds of uncontrolled asthma increased with disease duration in all patients living in EJ tracts, (p<.05). Living in the highest quartile of NO2 also increased the odds of uncontrolled asthma in severe patients, (p<.05), while there was no effect of TRAP on uncontrolled asthma in less severe patients (p>.05). Living in an EJ tract increased the odds of severe and uncontrolled asthma and was influenced by age at onset, disease duration, and potentially by TRAP exposure. This study underscores the need to better understand the complex environmental interactions which impact lung health in groups that have been economically and/or socially marginalized.

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