Individual factors, neighborhood social context and asthma at age 5 years

ABSTRACT

Objective: Childhood asthma is a major public health problem and its development is multifactorial. We examined whether neighborhood cohesion and disorder were associated with caregiver-report of asthma at age 5 years. Methods: This study is a secondary data analysis of the 2011–2012 United States National Survey of Children's Health. Data were available for 4680 children, age 5 years old born at term or preterm with birthweight >2500 g. Neighborhood disorder and cohesion were assessed based on caregivers' responses to validated questionnaires. Child asthma diagnosis was reported by the caregiver. Multivariable logistic regression was used to examine the relationship between these neighborhood factors and caregiver-report of child asthma, while accounting for individual level covariates. Results: Approximately two-thirds of the 4680 children were White and lived in households with income >400% of federal poverty line. Asthma was present in 399 (9%) children. Child female sex was associated with reduced risk of caregiver-reported asthma while non-Hispanic Black race and having smokers in the household were independently associated with increased risk in multivariable models. In these models, neighborhood disorder was significantly associated with asthma (adjusted Odds Ratio [aOR] 1.70, 95% Confidence Interval [CI] 1.04–2.78), while neighborhood cohesion was not (aOR 0.93, 95% CI 0.51–1.68). Conclusion: Even after adjustment for several individual level factors, neighborhood disorder was associated with caregiver-report of asthma in this nationally representative sample of 5-year-old children. Further research is needed to better understand how risk factors at different levels of the socio-ecological framework may interact to affect childhood asthma development.

KEYWORDS:

• Neighborhood cohesion
• neighborhood disorder
• children
• pediatric
• social determinants of health

Declaration of interest

No funding was secured for this study. The authors alone are responsible for the content and writing of this article. C.A. Camargo has done asthma-related consulting for GlaxoSmithKline, Merck, Novartis and Teva and received asthma-related grants from Novartis and Teva. The remaining authors have no conflicts of interest to disclose.