Exploring Neighborhood Opportunity as a Factor in Pediatric Asthma Visits to the Emergency Department

Despite growing interest in environmental and social determinants of health, few studies have explored how residential mobility influences respiratory health outcomes. We examined the relationship between levels of opportunity across education, health and environment, social and economic, and all domains in a child's neighborhood and the likelihood of emergency department (ED) visits for asthma and showed how moving from one neighborhood to another would affect the odds of visiting the ED for asthma. In this cross-sectional study, we analyzed asthma-related ED visits among children aged 2 to 17 years in 9 US states (Arizona, Florida, Kentucky, Maryland, New Jersey, North Carolina, Oregon, Rhode Island, and Wisconsin) during 2016-2019. We used a multivariable logistic regression model to examine the relationship between the Child Opportunity Index (COI) and ED visits for asthma. We used a piecewise linear logit model to estimate the neighborhood's opportunity effect. Children living in neighborhoods with very low COI had a high probability of visiting the ED for asthma (adjusted odd ratio = 1.14; P < .001). In addition, moving from a low to a very low COI neighborhood significantly increased the probability of asthma-related ED visits among children aged 5 to 9 years (0.8 percentage points), Black children (0.4 percentage points), boys (0.7 percentage points), and those living in large metropolitan areas (0.6 percentage points). Our findings suggest that improvement in neighborhood opportunity may translate to better asthma-related health outcomes among children. Future research should continue to investigate the effects of neighborhood opportunity on other childhood conditions.