Areas with High Rates of Police-Reported Violent Crime Have Higher Rates of Childhood Asthma Morbidity

Abstract

Objectives To assess whether population-level violent (and all) crime rates were associated with population-level child asthma utilization rates and predictive of patient-level risk of asthma reutilization after a hospitalization. Study design A retrospective cohort study of 4,638 pediatric asthma-related emergency department visits and hospitalizations between 2011 and 2013 was completed. For population-level analyses, census tract asthma utilization rates were calculated by dividing the number of utilization events within a tract by the child population. For patient-level analyses, hospitalized patients (n=981) were followed until time of first asthma-related reutilization. The primary predictor was the census tract rate of violent crime as recorded by the police; the all crime (violent plus non-violent) rate was also assessed. Results Census tract-level violent and all crime rates were significantly correlated with asthma utilization rates (both p<.0001). The violent crime rate explained 35% of the population-level asthma utilization variance and remained associated with increased utilization after adjustment for census tract poverty, unemployment, substandard housing, and traffic exposure (p=.002). The all crime rate explained 28% of the variance and was similarly associated with increased utilization after adjustment (p=.02). Hospitalized children trended toward being more likely to reutilize if they lived in higher violent (p=.1) and all crime areas (p=.01). After adjustment, neither relationship was significant. Conclusions Crime data could help facilitate early identification of potentially toxic stressors relevant to the control of asthma for populations and patients.

The Child Opportunity Index and Disparities in Pediatric Asthma Hospitalizations Across One Ohio Metropolitan Area, 2011-2013

“…(9, 28) We have also looked at other locally-available variables, “geomarkers” pertaining to housing code violations and exposure to crime. (7, 8) These data are potentially less useful in other locations while the COI is currently easily accessible and available for census tracts across 100 metropolitan areas. (17) Identifying whether our findings generalize to other municipalities could further support its use across population health efforts.…”

“…(7, 8) The calculation yielded an annual hospitalization rate measured per 1,000 children per year. We calculated a total utilization rate (all hospitalizations plus all ED visits) in the same manner.…”

“…Certain area-level measures of the SDH, including the percentage of individuals below the federal poverty level, are widely available and have shown value in characterizing inequities;(9, 13) however, such measures are crude and may not be amenable to immediate action. Other measures related to housing or crime(7, 8) provide nuanced, potentially-actionable detail but are typically local. There is a need for more generalizable measures with which to examine root causes and the broader context of inequities.…”

Mapping Neighborhood Health Geomarkers To Clinical Care Decisions To Promote Equity In Child Health

“…Finally, the psychosocial environment highlights community supports, access to mental health resources, and exposure to crime. 22–25 …”

“…23,25,47 Such geomarkers have value individually; they may also be informative when packaged into summary scores or indices. For example, we previously linked children hospitalized for asthma exacerbations to a “geo-risk” index constructed using census-tract measures of home values, poverty, and adult educational attainment (that is, geomarkers of the physical and economic environments).…”