Higher Rates Of Asthma Research Articles

African American Children Are More Likely to Be Allergic to Shellfish and Finfish: Findings from FORWARD, a Multisite Cohort Study

Despite major differences in health profiles and rates of health care utilization between African American and White children with food allergy (FA), the detailed phenotypic variables that can potentially impact these outcomes have not been thoroughly studied. We aimed to characterize phenotypic differences such as allergies to different foods and allergic comorbidities between African American and White children with FA enrolled in the Food Allergy Outcomes Related to White and African American Racial Differences study. Our active, prospective, multicenter cohort study is currently enrolling African American and White children aged 0 to 12 years diagnosed with FA and followed by allergy/immunology clinics at 4 urban tertiary centers in the United States. To evaluate associations between race and phenotypic variables, we used multivariable logistic regression, adjusting for important demographic and confounding factors, as well as potential household clustering. As of May 2020, there were 239 African Americans and 425 Whites with complete intake information enrolled in the study. In comparison with Whites, we found that African Americans had significantly higher adjusted odds of allergy to finfish (odds ratio [OR]: 2.54, P < .01) and shellfish (OR: 3.10, P< .001). African Americans also had higher adjusted odds of asthma than Whites (asthma prevalence of 60.5% in African Americans and 27.2% in Whites; OR: 2.70, P < .001). In addition, shellfish allergy was associated with asthma, after controlling for race. Among a diverse cohort of children with physician-diagnosed FA, we observed that African American children had higher odds of allergy to shellfish and finfish, and higher rates of asthma. Interestingly, having asthma was independently associated with allergy to shellfish, after controlling for race.

Electronic cigarette use patterns and chronic health conditions among people experiencing homelessness in MN: a statewide survey

BackgroundAdults experiencing homelessness have higher rates of disease and premature morbidity compared to the general population. Tobacco use is a primary contributing factor to these disparities; however, less is known regarding e-cigarette use patterns among adults experiencing homelessness and whether e-cigarettes are used in a manner that is narrowing or widening health disparities. This study aimed to describe the 1) prevalence and trends in e-cigarette use, 2) correlates of e-cigarettes use, and 3) rates of chronic health conditions by product use pattern in a community-based sample of adults experiencing homelessness.MethodsAdults experiencing homelessness in Minnesota were surveyed by self-report in 2015 (n = 3672) and 2018 (n = 4181) regarding e-cigarette and combustible cigarette use, potential correlates of e-cigarette use, and self-reported chronic health conditions (i.e., asthma, hypertension, diabetes, and cancer).ResultsFrequency of use increased from 2015 to 2018 for combustible cigarettes (66.9% vs. 72.3%), e-cigarettes (11.4% vs. 14.5%), and dual combustible/e-cigarette use (10.2% vs. 12.9%). The strongest bivariate correlates of past 30-day e-cigarette use were younger age, non-binary gender identification, non-heterosexual orientation, identification as White/Caucasian, greater frequency of lifetime homelessness, substance use, lack of regular place for medical care, mental health diagnosis, criminal justice involvement, and combustible cigarette smoking. Dual users had significantly higher rates of asthma and cancer than both those using combustible cigarettes and those using neither combustible nor e-cigarettes.ConclusionsDuring a time when cigarette smoking, e-cigarette use, and dual use were decreasing in the general population in Minnesota, rates increased in the homeless population. We observed that the rates of dual use were more than five times greater among homeless adults compared to the general population in 2018. Correlates of e-cigarette use were identified and should be used to identify subpopulations for intervention targeting. Mechanisms of the relationship between dual use and increased risks of health conditions deserve further study.

Quality of life in at—risk school-aged children with asthma

Introduction Asthma is the most common chronic condition of childhood. Urban, minority children from families of lower socioeconomic status have disproportionately higher rates of asthma and worse outcomes. We investigated the association between the presence of asthma and asthma severity among American, urban, minority children and reported quality of life (QOL) of children and their families. Methods We performed a prospective, cross-sectional study comparing QOL of urban, minority elementary school-age children with and without asthma. A convenience sample of children was enrolled from the pediatric emergency department (ED) and a specialized asthma clinic, at a large urban children’s hospital. We measured child and parent QOL using the Pediatric Quality of Life Inventory Version 4 (PEDSQL4), and evaluated associations with asthma, parental educational attainment, and frequency of ED visits. Results We enrolled 66 children, 76% were African American, and 61% were female. Overall child QOL was higher for those without asthma (p = 0.017, d = 0.59). Children with asthma also visited the ED almost twice as frequently (t [64] = −3.505, p < 0.001, d = 0.8), and parents of children with asthma reported a lower overall QOL (p = 0.04, d = 0.53) than those without asthma. Among children with asthma, a higher overall child QOL was associated with decreased asthma severity, more ED visits, and higher parental educational attainment. Conclusions Urban, minority elementary school-age children with asthma report a lower QOL than those children without asthma, and decreased asthma severity was associated with higher QOL.

Clinical characteristics vary between women and men in 67,524 patients with moderate obesity preoperative for laparoscopic adjustable gastric band (LAGB)

Background: As of 2018, LAGB represents &lt;2% of weight loss operations, but with excellent long-term outcomes in selected patients. Thus, every clinical insight can help in selecting LAGB patients and planning surgery. While more women than men undergo bariatric surgery, differences between the sexes in obesity-related clinical conditions pre-operatively among patients seeking LAGB have not been investigated. The objective of this study was to identify variations in obesity-related co-morbidities among women and men who chose laparoscopic adjustable gastric band (LAGB). Methods: Pre-operative data on 53,292 women and 14,222 men undergoing LAGB were examined retrospectively from the Surgical Review Corporation’s Bariatric Outcomes Longitudinal Database (BOLD). Results: Women were more frequently African American and on Medicaid while men were more frequently Caucasian insured with Medicare. Men were older, heavier, and used alcohol, tobacco, and illicit substances more frequently. Men had higher rates of cardiovascular and pulmonary disease, diabetes, gout, impaired functional status, abdominal hernia, and liver disease. Women had higher rates of asthma, cholelithiasis, urinary incontinence, panniculitis, and mental health. Conclusion: Pre-operative characteristics of LAGB patients vary by sex. This clinical knowledge may aid physicians and surgeons in facilitating anticipatory management of patients with moderate obesity

Cohort profile: Center for Research on Early Childhood Exposure and Development in Puerto Rico

PurposePuerto Rican children experience high rates of asthma and obesity. Further, infants born in Puerto Rico are more at risk for being born prematurely compared with infants on the mainland...

Preschool asthma: Examining environmental influences using geographic information systems.

This study was conducted to explore if environmental factors co-occur in areas with high asthma rates in Head Start (HS) children. Descriptive. Convenience sample of 56 children with asthma enrolled in HS, ages 3-5years. Geographic Information Systems using ArcGIS 10.4 was used to geocode and map aggregated address data at the census tract level through vector map analysis. Location, race, economic status, pollution remediation sites, age of housing, and blood lead levels were assessed for areas with high asthma concentration. Most children with asthma resided in one census tract, which was 1% of the total service area. Fifty-six percent of housing was built before 1960 with only 10% after 1990, suggesting deteriorating conditions. Pollution remediation sites were found in the vicinity of asthma cases. Elevated lead levels were found in 22% of all HS children; specific values for the children with asthma were not available. Several co-occurring factors were identified. The need for proactive interventions to decrease asthma risk/poor asthma outcomes with HS is evident. GIS locates children with high susceptibility to asthma. This allows public health nurses to target interventions and educate and empower families about environmental exposures and asthma risk factors.

Prevalence and incidence of bronchiectasis in Italy

BackgroundThe understanding of the epidemiology of bronchiectasis is still affected by major limitations with very few data published worldwide. The aim of this study was to estimate the epidemiological burden of bronchiectasis in Italy in the adult population followed-up by primary care physicians.MethodsThis study analyzed data coming from a large primary care database with 1,054,376 subjects in the period of time 2002–2015. Patients with bronchiectasis were selected by the use of International Statistical Classification of Diseases, 9th revision, Clinical Modification codes (ICD-9-CM).ResultsPatients with bronchiectasis were more likely to have a history of tuberculosis (0.47% vs. 0.06%, p < 0.0001), had higher rates of asthma (16.6% vs. 6.2%, p < 0.0001), COPD (23.3% vs. 6.4%, p < 0.0001) and rheumatoid arthritis (1.9% vs. 0.8%, p < 0.0001). The prevalence and incidence of bronchiectasis in primary care in Italy in 2015 were 163 per 100,000 population and 16.3 per 100,000 person-years, respectively. Prevalence and incidence increased with age and overall rates were highest in men over 75 years old. Prevalence and incidence computed after the exclusion of patients with a diagnosis of either asthma or COPD is 130 per 100,000 and 11.1 cases per 100,000 person-years, respectively.ConclusionsBronchiectasis is not a rare condition in Italian adult population. Further studies are needed to confirm our results and provide a better insight on etiology of bronchiectasis in Italy.Trial registrationnot applicable.

COPD and asthma in patients with opioid dependency: a cross-sectional study in primary care

Patients treated for drug addiction have high asthma and COPD prevalence rates. The relative contributions of cigarette smoking, smoking intensity and possible smoking of other substances has not been described. We aimed to describe the prevalence and determinants of asthma and COPD in patients prescribed methadone as opioid substitution therapy (OST). In a cross-sectional study of an anonymised patient-level primary care dataset of UK inner-city general practices (n = 46), 321,395 patients aged ≥18 years were identified. A total of 676 (0.21%) had a record of a methadone ever issued in primary care. The association between respiratory disease and methadone prescribing was examined using logistic regression. Models were adjusted for potential effects of clustering by practice. A total of 97.3% of patients prescribed methadone were cigarette smokers, either current (81.2%) or ex-smokers (16.1%). The prevalences of asthma and COPD were higher in methadone patients (14.2% and 12.4%, respectively) compared to non-methadone patients (4.4% and 1.1%, respectively). Methadone was an independent determinant of asthma, adjusting for smoking status (OR 3.21; 95% CI: 2.52, 4.10) or for smoking intensity (3.08; 2.27, 4.19), and of COPD, adjusting for smoking status (6.00; 4.61, 7.80) or for smoking intensity (5.80; 4.12, 8.17). COPD and asthma prevalence were substantially higher in those prescribed methadone compared to those never prescribed methadone. Prescription of methadone was an independent predictor for both COPD and asthma, even after adjustment for smoking status and smoking intensity. Possible explanations include confounding by association with smoking of heroin or crack cocaine, both of which may have a causal association with COPD and asthma.

Children’s Tobacco Smoke Exposure in Suffolk County Shelters: A Pilot Study to Determine Opportunities to Decrease Tobacco Smoke Exposure and Help Smokers Quit

Purpose: The prevalence of smoking among homeless adults is thought to be between 57% and 73%, around four times as high as in the general population. Children who live in shelters experience significant tobacco smoke exposure (TSE), and have disproportionately high rates of asthma and hospitalizations for TSE-related illnesses, yet only one published study has examined homeless parents’ perspectives on smoking. In order to reduce TSE-related morbidity in homeless children, this study seeks to better understand the …

Increasing Childhood Asthma Care Appointments on a Mobile Asthma Van

Children in two communities of a large city in the Midwestern United States have higher rates of asthma than other areas of the city. The communities have barriers to accessing care, including high rates of unemployment and being uninsured and undocumented. A mobile van provides no-cost asthma care to children at schools in these communities, but use of these services has decreased more than 50% over the past 5 years. School nurses have the potential to improve asthma outcomes by collaborating with health-care providers. The purpose of the program was to increase the number of appointments scheduled and attended on the asthma van at both schools. For this program, we (a) implemented an unaccompanied minor consent, (b) enhanced care coordination, and (c) improved a respiratory health survey tool. Results showed an increased number of appointments scheduled and attended on the asthma van. The program was successful even though community-specific barriers existed.

Development and evaluation of pollen source methodologies for the Victorian Grass Pollen Emissions Module VGPEM1.0

Abstract. We present the first representation of grass pollen in a 3-D dispersion model in Australia, tested using observations from eight counting sites in Victoria. The region's population has high rates of allergic rhinitis and asthma, and this has been linked to the high incidence of grass pollen allergy. Despite this, grass pollen dispersion in the Australian atmosphere has not been studied previously, and its source strength is untested. We describe 10 pollen emission source methodologies examining the strengths of different immediate and seasonal timing functions, and the spatial distribution of the sources. The timing function assumes a smooth seasonal term, modulated by an hourly meteorological function. A simple Gaussian representation of the pollen season worked well (average r=0.54), but lacked the spatial and temporal variation that the satellite-derived enhanced vegetation index (EVI) can provide. However, poor results were obtained using the EVI gradient (average r=0.35), which provides the timing when grass turns from maximum greenness to a drying and flowering period; this is due to noise in the spatial and temporal variability from this combined spatial and seasonal term. Better results were obtained using statistical methods that combine elements of the EVI dataset, a smooth seasonal term and instantaneous variation based on historical grass pollen observations (average r=0.69). The seasonal magnitude is inferred from the maximum winter-time EVI, whereas the timing of the season peak is based on the day of the year when the EVI falls to 0.05 below its winter maximum. Measurements are vital to monitor changes in the pollen season, and the new pollen measurement sites in the Victorian network should be maintained.

Bad Lungs/Bad Air: Childhood Asthma and Ecosyndemics among Mexican Immigrant Farmworkers of California's San Joaquin Valley

California's San Joaquin Valley, one of the most highly productive—and contaminated—agricultural regions in the world, is beset by some of the nation's worst air quality and high rates of childhood asthma. Children of Mexican-origin farmworkers in the San Joaquin Valley have exceptionally high rates of asthma compared with children of Mexican descent in both the United States and Mexico. We suggest that public health paradigms, which posit that Mexican-American children are at relatively low risk of developing childhood asthma, do not apply to the population of children of Mexican immigrant farmworkers in the San Joaquin Valley. Combining ethnographic and photovoice methods, we demonstrate how industrial farming conditions systematically expose children of farmworkers to environmental insults over which they have little or no control, including pesticide exposure, bovine contamination, agricultural field burning, and substandard housing, all of which contribute to high prevalence of asthma among children. We argue that the application of structural vulnerability, structural violence, and ecosyndemic frameworks can be used to better explicate complex environmental injustices that might otherwise be overlooked by more reductionistic theories.

Gun Violence and Cardiovascular Health.

Gun Violence and Cardiovascular Health.

Mapping inequality: Childhood asthma and environmental injustice, a case study of St. Louis, Missouri

As a geographic continuum of poverty and affluence has emerged, so too has a geographic continuum of good and poor health. Asthma is currently one of the most prevalent chronic childhood diseases. Over the past three decades, the greatest increases in asthma rates have been in urban areas and have disproportionately affected youth in poverty and those in racial and ethnic minority groups. Neighborhoods serve as a mechanism fostering environmental injustice and perpetuating these disparities in health outcomes and life opportunity for our most vulnerable populations. Using Geographic Information Systems (GIS) methods in a case study of St. Louis Missouri, this study examines local environmental risk by identifying ‘hotspots,’ or statistically significant spatial clustering of high or low levels of childhood asthma, and associations with neighborhood characteristics, socio-demographic characteristics, and access to healthcare resources within these hotspots. Results revealed statistically significant clustering of high asthma rates in areas with more non-White and poor residents, higher rates of public housing, deteriorating housing, and violent crime. High asthma hotspots were also located in areas with limited physical access to healthcare resources, such as physicians and medication, and lower school attendance rates. Residents of these high asthma hotspots experience greater environmental risk, and significant disparities in health and education outcomes, physical and financial healthcare resources, and overall well-being. This study demonstrates these place-based inequalities and presents clear evidence of environmental injustice, supporting the need for investments and interventions to improve the environments, health, and economic resources of our most vulnerable youth.

Asthma status and risks among lesbian, gay, and bisexual adults in the United States: A scoping review

Asthma is uncontrolled in up to 71% of adolescents and adults, 1 Murphy K.R. Meltzer E.O. Blaiss M.S. Nathan R.A. Stoloff S.W. Doherty D.E. Asthma management and control in the United States: results of the 2009 Asthma Insight and Management survey. Allergy Asthma Proc. 2012; 33: 54-64 Crossref PubMed Scopus (103) Google Scholar resulting in higher health care costs, more school and work absences, and higher mortality. 1 Murphy K.R. Meltzer E.O. Blaiss M.S. Nathan R.A. Stoloff S.W. Doherty D.E. Asthma management and control in the United States: results of the 2009 Asthma Insight and Management survey. Allergy Asthma Proc. 2012; 33: 54-64 Crossref PubMed Scopus (103) Google Scholar , 2 Centers for Disease Control and PreventionTrends in asthma prevalence, health care use, and mortality in the United States, 2001-2010. NCHS Data Brief. 2012; : 1-8 Google Scholar Sexual minority (SM) adults (eg, people who identify as lesbian, gay, or bisexual or who have same-sex partners) have higher rates of asthma than their heterosexual counterparts. 3 Gao J. Mansh M. Sexual orientation disparities in the prevalence of asthma and allergic rhinitis among US adults. Ann Allergy Asthma Immunol. 2016; 117: 435-437 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 4 Gonzales G. Przedworski J. Henning-Smith C. Comparison of health and health risk factors between lesbian, gay, and bisexual adults and heterosexual adults in the United States. JAMA Intern Med. 2016; 176: 1344-1348 Crossref PubMed Scopus (236) Google Scholar However, it is unclear whether rates and risk factors differ by sexual identity subgroups (eg, bisexual, men, lesbian). To address this critical knowledge gap, we conducted a scoping review to systematically search relevant literature following current guidelines. 5 Colquhoun H.L. Levac D. O'Brien K.K. et al. Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol. 2014; 67: 1291-1294 Abstract Full Text Full Text PDF PubMed Scopus (1287) Google Scholar Scoping reviews are ideal for addressing research questions in areas with emerging evidence, such as SM health. English-language original research articles on rates, risks, and outcomes of asthma in the United States published between January 1, 2000, and July 31, 2017, were included. We had no age restrictions for the samples but excluded studies focused on HIV/AIDS and on transgender individuals because, although they share some risks with SM adults, health status and access differ substantially.

Generational Patterns of Asthma Incidence among Immigrants to Canada over Two Decades. A Population-based Cohort Study.

Canada, an industrialized country with high endemic asthma rates, is characterized by a large immigrant population. We sought to provide insight into the relative contribution of environmental exposure to asthma risk by comparing asthma rates among recent immigrants relative to long-term residents of Canada. This was a population-based, retrospective cohort study performed using provincial health administrative data for all residents of Ontario, Canada. Residents with and without a diagnosis of asthma from fiscal years 1996-2012 were included. Individuals were categorized as being immigrants (landed in Canada after 1985) or long-term residents of Ontario by linkage with the Immigration, Refugees, and Citizenship Canada's Permanent Resident Database. We calculated the age- and sex-standardized incidence of asthma among residents of Ontario, and compared the incidence of asthma among immigrants and long-term residents using incidence rate ratios (IRRs). Analysis of approximately 11.7 million records showed that 2.2 immigrants arrived in Canada during the study period, with over 50% from East and South Asia and the Pacific. We found that asthma incidence was lower among immigrants compared with long-term residents (IRR = 0.30; 95% confidence interval = 0.30-0.30; P < 0.001). However, Ontario-born children of immigrants from most world regions had significantly higher asthma incidence compared with children of long-term residents (IRR = 1.44; 95% confidence interval = 1.43-1.45; P < 0.001). The overall incidence of asthma in Ontario decreased between 1996 and 2012 (Ptrend < 0.001). Immigrants contributed to only a small proportion of the asthma incidence in Ontario, and changes within this group did not significantly affect trends in the overall Ontario population asthma incidence. The higher asthma incidence seen among children of immigrants, but not in their parents, suggests that being born in Canada was critical for determining asthma risk. These findings support the importance of in utero and/or early life exposures on asthma development.

Type 2 Diabetes and Asthma: Systematic Review of the Bidirectional Relationship.

Obesity is an important contributor to the risk of both asthma and Type 2 Diabetes (T2DM). However, it has been suggested that T2DM and asthma are also independently associated. The aim of this systematic review was to synthesize the evidence for an independent relationship between T2DM and asthma. MEDLINE and EMBASE were searched for studies reporting the relationship between asthma and T2DM in adults. Given a potential bidirectional relationship, articles relating to T2DM as a risk factor for asthma, and asthma as a risk factor for T2DM were examined separately. Eight studies were identified for inclusion in the review (n=2,934,399 participants). Four studies examined incident diabetes in those with asthma. The pooled (random effects model) adjusted hazard ratio for incident T2DM in asthma was 1.37 (95%CI 1.12-1.69; p <0.001) after controlling for BMI. Four studies reported prevalence or incidence rates of asthma in people with T2DM; higher rates of asthma in those with T2DM were reported in all four studies. Meta-analysis of results was not possible due to methodological heterogeneity. The quality of included studies was good, but due to small numbers, publication bias cannot be excluded. The published literature suggests a bidirectional independent relationship between T2DM and asthma, although we cannot exclude publication bias.

The Role of Place as a Modifier of Asthma Associations among Children in Seattle

Asthma is the most common chronic illness of childhood and its prevalence is increasing, causing much concern for identification of risk factors. Previous work in Seattle has identified strong associations between air pollution and pediatric asthma emergency department (ED) visits. According to the CDC, Washington State&amp;#8217;s asthma prevalence is among the highest in the nation and steadily increasing. Higher rates of asthma are found in African American children, and while many factors including socio-economic status and birth weight have been shown to be related to asthma prevalence, it has been difficult to account for the difference between various races. Here we examine whether this racial difference can be explained by neighborhood characteristics, such as racial composition, socioeconomic status, and land use. We use the Comprehensive Hospital Abstract Reporting System (CHARS) data from 2009-2016 in Seattle, WA and air pollution data from the Community Multiscale Air Quality Modeling System (CMAQ) along with neighborhood socioeconomic data (median income, percent below poverty, percent unemployed and percent white) from the American Community Survey (ACS) and land use data to explore the relationship between hospital admission rates for asthma and air pollution, race, and neighborhood characteristics. We use panel data statistical methods to explore these associations. Preliminary results demonstrate that in Seattle there are 8,315 ER visits for a primary or secondary diagnosis of asthma in children between the ages of 0-18. African Americans represent 7.0% of the population in Seattle yet of the pediatric visits, 1,225 (14.7%) were for African American children. The zipcodes with the highest counts of asthma also have higher ethnic diversity (&amp;gt; 20% black and &amp;lt; 30% white), high population density (&amp;gt; 5300/ mile2 compared to the average in Seattle of 4721/ mile2) and are lower income neighborhoods (median household income &amp;lt; $67,000 compared to $75,000 in Seattle).

Multivariate analysis of inflammatory endotypes in recurrent nasal polyposis in a Chinese population.

Chronic rhinosinusitis with nasal polyps (CRSwNP) remains a challenging clinical problem due to its propensity for recurrence. However, data on the frequency of CRSwNP recurrence after surgery in China are rare. 78 CRSwNP patients undergoing functional endoscopic sinus surgery were followed-up for 8 years and classified into recurrent and non-recurrent groups. A cluster analysis of the CRSwNP based on inflammatory endotypes was performed, and the endotypes were secondarily matched with clinical phenotypes. The recurrence rate of CRSwNP in Southwest China was 21.8% over 8 years post-surgery. The CRSwNP was classified into 4 clusters: cluster 1 (higher expression of IL-5, IgE, and ECP and high positivity rate for SE-IgE); cluster 2 (higher concentrations of IL-6, IL-8 and MPO); cluster 3 (higher concentrations of TNF-alpha; and IFN-gamma); and cluster 4 (higher expression of IL-17). Cluster 1 (type-2 inflammation) exhibited the highest recurrence rate, co-morbid asthma and atopy. Notably, the ECP/MPO ratio increased significantly in patients with non-type-2 recurrent CRSwNP 8 years after the first surgery. Different inflammatory endotypes of CRSwNP exhibited clearly different prognoses. The type-2 subgroup had high recurrence and co-morbid asthma rates comparable to the rates reported in Western countries.

Health care access, concentrated poverty, and pediatric asthma hospital care use in California's San Joaquin Valley: A multilevel approach

ABSTRACTBackground: California's San Joaquin Valley is a region with a history of poverty, low health care access, and high rates of pediatric asthma. It is important to understand the potential barriers to care that challenge vulnerable populations. Objective: The objective was to describe pediatric asthma-related utilization patterns in the emergency department (ED) and hospital by insurance coverage as well as to identify contributing individual-level indicators (age, sex, race/ethnicity, and insurance coverage) and neighborhood-level indicators of health care access. Methods: This was a retrospective study based on secondary data from California hospital and ED records 2007–2012. Children who used services for asthma-related conditions, were aged 0–14 years, Hispanic or non-Hispanic white, and resided in the San Joaquin Valley were included in the analysis. Poisson multilevel modeling was used to control for individual- and neighborhood-level factors. Results: The effect of insurance coverage on asthma ED visits and hospitalizations was modified by the neighborhood-level percentage of concentrated poverty (RR = 1.01, 95% CI = 1.01–1.02; RR = 1.03, 95% CI = 1.02–1.04, respectively). The effect of insurance coverage on asthma hospitalizations was completely explained by the neighborhood-level percentage of concentrated poverty. Conclusions: Observed effects of insurance coverage on hospital care use were significantly modified by neighborhood-level measures of health care access and concentrated poverty. This suggests not only an overall greater risk for poor children on Medi-Cal, but also a greater vulnerability or response to neighborhood social factors such as socioeconomic status, community cohesiveness, crime, and racial/ethnic segregation.