The Role of Neighborhood Air Pollution in Disparate Racial and Ethnic Asthma Acute Care Use.

Abstract

The share of Black or Latinx residents in a census tract remains associated with asthma-related Emergency Department visit rates after controlling for socioeconomic factors. The extent to which evident disparities relate to within-city heterogeneity of long-term air pollution exposure remains unclear. To investigate the role of intraurban spatial variability of air pollution in asthma acute care use disparity. An administrative database was used to define census tract population-based incidence rates of asthma-related Emergency Department visits. We estimate the association between census tract incidence rates and (a) average fine and coarse particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), and sulfur dioxide (SO2); and (b) racial/ethnic composition using generalized linear models controlling for socioeconomic and housing covariates. We additionally examine for attenuation of incidence risk ratios (IRR) associated with race/ethnicity when controlling for air pollution exposure. PM2.5, PM10, and SO2 are each associated with census tract-level incidence rates of asthma-related ED visits and multipollutant models show evidence of independent risk associated with PM10 and SO2. Association between census tract incidence rates and Black resident share (IRR [CI] = 1.51 [1.48-1.54]) is attenuated by 24% when accounting for air pollution (1.39 [1.35-1.42]), and the association with Latinx resident share (1.11 [1.09-1.13]) is attenuated by 32% (1.08 [1.06-1.10]). Neighborhood-level rates of asthma acute care use are associated with local air pollution. Controlling for air pollution attenuates associations with census tract racial/ethnic composition, suggesting that intracity variability in air pollution could contribute to neighborhood-to-neighborhood asthma morbidity disparities.