Introduction

Studies suggest that neighborhood conditions influence pediatric respiratory health, but few accounted for residential greenness and atopic history. We studied the link between the Child Opportunity Index (COI), a quality measure of neighborhood resources, and asthma exacerbations, assessing interaction by atopic history and adjusting for residential greenness.

Methods

We studied children with asthma (ages 5-17) receiving primary care in the Mount Sinai Health System (2013-2021), using electronic health record data. We assessed associations between overall and domain-specific COI z-scores (SES: Social and Economic; ED: Education; HE: Health and Environment), and asthma exacerbation (any hospitalization, emergency department visit, or outpatient oral corticosteroid use) in the subsequent year. We used mixed-effects logistic regression, adjusting for age, sex, race/ethnicity, insurance, and interaction by atopic history. In extended models, we adjusted for residential greenness, using Normalized Difference Vegetation Index (NDVI) scores at 300-meter buffers with Landsat data (summer, 2012-2021).

Results

Among 4,579 children with asthma, 16.6% (n=761) experienced exacerbation. Higher overall COI was associated with lower exacerbation risk (RR:0.62; 95%CI:0.50-0.75), with similar findings for domain-specific COI scores. Findings suggest interaction by atopic history (p=0.04), with stronger protective associations among those without atopy (Non-atopy RR:0.25; 95%CI:0.13-0.48; Atopy RR:0.67; 95%CI:0.54-0.83). After adjusting for residential greenness, COI remained protective, but interaction by atopy was no longer significant (p>0.05).

Discussion

Greater neighborhood opportunity is linked with reduced pediatric asthma exacerbation risk. Interaction by atopy was observed before adjusting for residential greenness. Considering both patient atopy and environmental exposures can improve understanding of how neighborhood resources influence pediatric asthma burden.