Elsevier

Health & Place

Volume 12, Issue 2, June 2006, Pages 167-179
Health & Place

Urban asthma and the neighbourhood environment in New York City

https://doi.org/10.1016/j.healthplace.2004.11.002Get rights and content

Abstract

Asthma is now the leading cause of emergency room visits, hospitalizations, and missed school days in New York City's poorest neighbourhoods. While most research focuses on the influence of the indoor environment on asthma, this study examines the neighbourhood effects on childhood asthma, such as housing and ambient environmental hazards. Using Geographic Information Science (GIScience) we identify neighbourhoods with elevated concentrations of childhood asthma hospitalizations between 1997 and 2000 in US census tracts, analyze the sociodemographic, housing characteristics, and air pollution burdens from stationary, land use and mobile sources in these areas. The paper reveals the importance of distinguishing the specific and often different combinations of poor housing conditions, outdoor air pollution and noxious land uses that contribute to the high incidence of asthma in impoverished urban neighbourhoods.

Introduction

Urban asthma is frequently described as one of America's fastest growing epidemics. The epidemic is particularly acute among poor, African-American and Latino children living in urban neighbourhoods. While the national prevalence of childhood asthma in 1999 was approximately 7% for all children under 15-years old, African-American children living below the poverty line were 15–20% more likely to have asthma (CDC, 2002). In large urban areas, the prevalence of asthma is even more severe. For instance, in New York City 17% of children have experienced asthma-like symptoms at some point in their lives (New York City Department of Health (NYC DOH), 1999). Children living in poor New York City neighbourhoods bear the heaviest burden of the disease and are three times more likely to be hospitalized for asthma as children who live in wealthy neighbourhoods (NYC DOH, 2003; Claudio et al., 1999). Asthma is the leading cause for emergency room evaluations, pediatric hospitalizations, and school absenteeism in New York City (NYC DOH, 2003).

Numerous factors are believed to be behind the distribution of urban asthma. Residential exposures, including environmental tobacco smoke and in-home allergens common in poor quality housing, such as mold and cockroach allergens, are consistently associated with the development and exacerbation of asthma (Sears, 1997; Weiss et al., 1993). Exposure to outdoor air pollutants, including ozone (O3), particulate matter (PM) and hazardous air pollutants (HAPs), are also known risk factors for developing respiratory diseases, including asthma (Strachan, 2000; Gent et al., 2003; Delfino et al., 2003). While traditional asthma epidemiology has focused on individual and family level risk factors, many of the suspected contributors to asthma (both its onset and triggering once one has the disease) have contextual or neighbourhood effects. Neighbourhood physical characteristics frequently associated with asthma include poor housing quality and disproportionate environmental pollution burdens regularly found in low-income, minority urban neighbourhoods (Mott, 1995; Krieger and Higgins, 2002).

Increasingly, public health researchers have shown that neighbourhood or area characteristics may be related to health independently of individual-level attributes (Diez Roux, 2001; MacIntyre et al., 2002). The emerging field of social epidemiology emphasizes that both physical and social characteristics of neighbourhoods, such as persistent poverty, residential segregation, psychosocial stress, unemployment, inadequate transportation, lack of affordable food stores, unsafe recreation spaces, high crime rates, biased policing, concentrated environmental hazards, and social networks, are important for understanding population distributions of disease and well being (Kawachi and Berkman, 2003). This view of public health suggests that disease is not determined entirely by an individual's biologic composition, or “who you are,” or social context, or “where you are,” but rather both/and; so, who you are depends in part on where you are. However, with a few exceptions, the relationships between the physical characteristics of urban neighbourhoods and asthma have rarely been studied (Ledogar et al., 2000; Brugge et al., 2003; Wright and Fisher, 2003). Additionally, the few studies focusing on neighbourhood characteristics and asthma tend to examine one neighbourhood without performing cross-neighbourhood comparisons.

This paper seeks to assess the neighbourhood effects on childhood asthma hospitalization rates in New York City by analyzing the environmental characteristics of neighbourhoods that may be contributing to the onset and triggering of the disease and comparing across different neighbourhoods throughout the City. We aim to investigate the role of the physical neighborhood environment on childhood asthma hospitalization rates in New York City with a research premise that neighborhoods are important units for studying the contextual effects on health because their physical, social and economic characteristics all help structure the health status of populations living in them. Thus, the theoretical thrust behind our study is that the relationship between health and place is undeniable, but particular aspects of this relationship, including mechanisms and weight of particular neighborhood characteristics, have been inadequately explored.

While asthma hospitalization data are limited because they tend to reflect who seeks emergency treatment and do not necessarily represent asthma prevalence, these are the only asthma data currently available at the neighbourhood scale for all of New York City. Using childhood asthma hospitalization rates for the years 1997–2000 aggregated by US Census tracts, we analyze the relationship of asthma hospitalization rates and socio-demographic factors, neighbourhood housing quality, and environmental exposures such as polluting facilities, noxious land uses, and mobile-source air pollution. The purposes of the study are to identify, using Geographic Information Science (GIScience) techniques, New York City neighbourhoods with consistently high asthma hospitalization rates (some of the highest rates ever recorded in the United States) and analyze some of the neighbourhood-specific hazards, including housing and environmental exposures, frequently associated with urban asthma. A goal of this research is to better direct asthma management and prevention policies aimed at the neighbourhood and metropolitan scale.

Section snippets

Methods

Using GIScience methods, we analyse and map the spatial distribution of social and physical characteristics that appear to affect population health both within and across different neighborhoods in the same city. In order to combine mapping with spatial statistical tools, we selected GIScience methods. GIScience includes numerous analytic tools missing in other commonly used neighborhood-effect research methods, such as multilevel analyses, including techniques for spatially defining

Defining neighbourhood asthma hotspots

All data were entered into a Geographic Information System using Arcview software from Environmental Systems Research Inc., (http://www.esri.com). The first stage involved determining the location of asthma “neighbourhood hotspots,” or neighbourhoods with consistently elevated asthma hospitalization rates for children under 14-years old. We defined a hotspot as contiguous census tracts where the observed asthma hospitalization rate exceeded the expected rate with a 90% confidence interval.

Neighbourhood characteristics

Asthma hospitalization rates for all children 0–14 years old between 1997 and 2000 in our “hotspot” neighbourhoods were 12.4 per 1000 persons, nearly three times the national average of 4.2 per 1000 persons and twice the NYC average of 6.4 per 1000 persons (NYC DOH, 2003) (Table 1). These rates are consistent with earlier studies by Carr et al. (1992) that found the annual hospitalization rate in New York City between 1982 and 1986 was 3.9 per 1000 and Claudio et al. (1999) who calculated a

Discussion

This study has shown a positive correlation between a set of social and physical neighbourhood characteristics and asthma hospitalization rates for urban children living in New York City neighbourhoods. These characteristics include low median household income, high percentage minority, public and inadequate housing, and multiple environmental pollution burdens. We have also mapped some of our results to visually display the relationships between asthma hospitalization rates and selected

Housing conditions

Having a low-income, being a minority and living in substandard housing appear to be strong neighbourhood predictors of asthma hospitalizations. Deteriorating and dilapidated housing is likely to increase resident's exposure to indoor air pollutants known to trigger asthma, such as rodent and cockroach allergens, mold, mildew, and dust mites (Rauh et al., 2002). Substandard housing conditions may contribute to increased exposure to nitrogen dioxide, from inadequately vented or poorly

Environmental exposures

Our findings documenting the neighbourhood “environmental load” are also consistent with prior studies documenting that poor and minority communities have higher concentrations of polluting facilities and harmful air pollutants, such as diesel particulate matter that lodges in the lungs and contributes to respiratory disease (Kinney et al., 2000; Olden, 1996). A study by the American Lung Association found that over half of pediatric asthma cases occur in areas in non-attainment of EPA's air

Study limits

As noted in the introduction, our study is limited by the fact that we use asthma hospitalization data as a surrogate for asthma prevalence. Since we were concerned with neighbourhood characteristics, the hospitalization data we obtained did not include individual patient information. Associations we observe from neighbourhood characteristics may not necessarily hold true for specific individuals. Our hospitalization data also did not allow us to screen-out multiple admissions of the same

Conclusions

This study has shown that neighbourhood context does matter for understanding the distribution of childhood asthma hospitalization rates in New York City. Our study has shown that an ecological approach is necessary for both studying and developing intervention strategies to address urban asthma. Understanding the neighbourhood effects on urban asthma will continue to require the use of emerging GIScience tools, some of which have been employed here. However, more detailed investigation are

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