The Interplay of Pollution, Child Opportunity, and High Health Care Utilization in Children With Asthma in San Diego County
Tatyana G. Mills, Kelly Robinson, Suzan Mahdai, Sweta Parija, Jacob Parker, Manaswitha Khare, Margaret Nguyen, Sydney LeibelObjectives:
This study aims to (1) compare air pollution and child opportunity between neighborhoods with and without high health care utilization (HHU) for asthma, and (2) compare health care utilization frequency by race, ethnicity, primary language, and insurance type at the patient level.
Methods:
This retrospective cohort study examined children with asthma within the Rady Children’s Health System (2015-2020) who met HHU criteria [≥2 emergency department (ED) visits in 6 months or ≥2 hospitalizations in 12 mo]. Patient addresses were geocoded to census tracts, and ArcGIS was used to map CalEnviroScore 4.0 and the Child Opportunity Index. Descriptive statistics assessed health care utilization differences based on patient demographics.
Results:
This study included 1070 individuals. The median HHU asthma rate was 1.7 per 1000 children (interquartile range: 0.9 to 3.1) across 408 census tracts. Pollution burden was significantly higher in tracts with HHU asthma cases than those without (
Conclusions:
We identified disparities in pollution and child opportunity among pediatric asthma patients with HHU. These differences are linked to race, ethnicity, and insurance type. These findings can guide efforts to improve child health equity.