Air Pollution, Urgent Asthma Medical Visits and the Modifying Effect of Neighborhood Asthma Prevalence

Lovinsky-Desir, Stephanie; Acosta, Luis M.; Rundle, Andrew G.; Miller, Rachel L.; Goldstein, Inge; Jacobson, Judith S.; Chillrud, Steven N.; Perzanowski, Matthew S.

Background: Social and environmental stressors, may modify associations between environmental pollutants and asthma symptoms. We examined if neighborhood asthma prevalence (higher: HAPN vs. lower: LAPN), a surrogate for underlying risk factors for asthma, modified the relationship between pollutants and urgent asthma visits.
Methods: Through zip code, home addresses were linked to New York City Community Air Survey’s land use regression model for street-level, annual average nitrogen dioxide (NO2), particulate matter (PM2.5), elemental carbon (EC); summer average ozone (O3); winter average sulfur dioxide (SO2) concentrations. Poisson regression models were fit to estimate the association (prevalence ratio, PR) between pollutant exposures and seeking urgent asthma care.
Results: All pollutants, except O3 were higher in HAPN than LAPN (P<0.01) Neighborhood asthma prevalence modified the relationship between pollutants and urgent asthma (P-interaction<0.01, for NO2 and SO3). Associations between pollutants and urgent asthma were observed only in LAPN (NO2: PR=1.38, P=0.01; SO3: PR=1.85, P=0.04). No association was observed between pollutants and urgent asthma among children in HAPN (P>0.05).
Conclusions: Relationships between modeled street-level pollutants and urgent asthma were stronger in LAPN compared to HAPN. Social stressors that may be more prevalent in HAPN than LAPN, could play a greater role in asthma exacerbations in HAPN versus pollutant exposure alone.

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