Abstract Rationale Neighborhood asthma prevalence (NAP) varies (3-19%) in New York City (NYC), We previously found no associations of asthma severity indicators (e.g., wheeze frequency, lung function, exhaled NO) with lower versus higher NAP. Visible mold has been linked to asthma symptoms. Missed school days are a useful metric of asthma morbidity because of its detrimental impacts on student learning. We hypothesized that asthmatic children with reports of mold in their home would be more likely to miss school days. Methods The NYC Neighborhood Asthma and Allergy Study is a case-controlled study assessing asthma among middle-income children living in higher asthma prevalence neighborhoods (HAPN) and lower asthma prevalence neighborhoods (LAPN). Seven- and eight-year-old children (n = 201) from HAPNs (n = 104) and LAPNs (n = 97) were recruited through the same middle-income health insurance plan. Parents were queried about asthma symptoms, number of school days missed for asthma, and reports of visible mold. Asthma prevalence cutpoints for LAPN (9%) and HAPN (11%) were used. Prevalence ratios (PR) were calculated using generalized estimating equation models controlling for sex, maternal asthma, carpeted floor, building type, dustborne cockroach and mouse allergens, neighborhood-level elemental outdoor black carbon and median household income. Results Children who missed 5 days of school (18.4%) in the past 12 months were more likely to have more frequent asthma symptoms (83.3% vs. 29.9%, P 0.001) and lower lung function (0.84 vs. 0.87 mean FEV1/FVC ratio, P = 0.009). Missing 5 days of school was slightly but not significantly (P 0.05) more common among children living in HAPN vs LAPN (23.1% vs. 13.4%), as were frequent asthma symptoms (45.2% vs. 34.0%). The prevalence of reported visible mold at home between LAPN (42.3%) and HAPN (38.5%) was similar. Visible mold reported in the home was independently associated with missed school days (PR 2.11 P = 0.033) and remained independently associated with mold when frequent asthma symptoms were included in the analyses (PR 2.06, P = 0.041]) Frequent symptoms PR = 6.92, P = 0.001. In stratified multivariable models, visible mold was associated with 5 missed school days among children living in HAPN (PR = 3.79, P = 0.005], but not LAPN (PR = 0.80, P = 0.72, Pinteraction=0.054). Unadjusted analyses with continuous neighborhood asthma prevalence visualized in Figure. Conclusions Report of mold in the home was associated with missed school days among children with asthma independent of other domestic asthma triggers and risk factors. This occurred only in the higher asthma prevalence neighborhoods, which could be modified by yet unidentified factors associated with neighborhoods. This abstract is funded by: R01 ES 014400 and P30 ES 009089, Housing and Urban Development Healthy Homes Technical Studies grant NYHHU 0003-11
Kimpo et al. (Fri,) studied this question.