The influence of urban exposures and residence on childhood asthma

Abstract

Children with asthma who live in urban neighborhoods experience a disproportionately high asthma burden, with increased incident asthma and increased asthma symptoms, exacerbations, and acute visits and hospitalizations for asthma. There are multiple urban exposures that contribute to pediatric asthma morbidity, including exposure to pest allergens, mold, endotoxin, and indoor and outdoor air pollution. Children living in urban neighborhoods also experience inequities in social determinants of health, such as increased poverty, substandard housing quality, increased rates of obesity, and increased chronic stress. These disparities then in turn can increase the risk of urban exposures and compound asthma morbidity as poor housing repair is a risk factor for pest infestation and mold exposure and poverty is a risk factor for exposure to air pollution. Environmental interventions to reduce in‐home allergen concentrations have yielded inconsistent results. Population‐level interventions including smoking bans in public places and legislation to decrease traffic‐related air pollution have been successful at reducing asthma morbidity and improving lung function growth. Given the interface and synergy between urban exposures and social determinants of health, it is likely population and community‐level changes will be needed to decrease the excess asthma burden in children living in urban neighborhoods.

Association of Exclusive Breastfeeding with Asthma Risk among Preschool Children: An Analysis of National Health and Nutrition Examination Survey Data, 1999 to 2014

“…Fourth, family medical history and environmental factors may increase children’s asthma risk. For example, a family history of allergic diseases, pets in the family home, and/or living in an urban or rural area are all potential influencing factors [ 44 , 45 , 46 ]. Researchers should consider such factors in future analysis.…”

Environment and the development of severe asthma in inner city population

“…Children living in inner-cities encounter high mold exposure at home and in schools [4,14]. Prior studies have demonstrated that mold sensitization was more common in patients with severe asthma, poor symptom control, and more frequent exacerbations.…”

Socioeconomic determinants of asthma health

“…Ambient environmental exposures also differentially affect asthmatic children in low-income, urban environments, primarily due to air pollution in the form of nitrogen dioxide (NO 2 ) and particulate matter generated by traffic or industrial processes [19,23,27,28]. Anenberg et al [29] utilized land use regression models to estimate incident asthma globally in 2019 by scaling exposure models based on over 5000 NO 2 monitors in 58 countries.…”