{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T16:09:51Z","timestamp":1788883791089,"version":"build-2803163510"},"reference-count":55,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"<jats:sec id=\"ab-poi230049-4\"><jats:title>Background<\/jats:title><jats:p>The extent to which physical and social attributes of neighborhoods play a role in childhood asthma remains understudied.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi230049-5\"><jats:title>Objective<\/jats:title><jats:p>To examine associations of neighborhood-level opportunity and social vulnerability measures with childhood asthma incidence.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi230049-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cohort study used data from children in 46 cohorts participating in the Environmental Influences on Child Health Outcomes (ECHO) Program between January 1, 1995, and August 31, 2022. Participant inclusion required at least 1 geocoded residential address from birth and parent or caregiver report of a physician\u2019s diagnosis of asthma. Participants were followed up to the date of asthma diagnosis, date of last visit or loss to follow-up, or age 20 years.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi230049-7\"><jats:title>Exposures<\/jats:title><jats:p>Census tract\u2013level Child Opportunity Index (COI) and Social Vulnerability Index (SVI) at birth, infancy, or early childhood, grouped into very low (&amp;amp;lt;20th percentile), low (20th to &amp;amp;lt;40th percentile), moderate (40th to &amp;amp;lt;60th percentile), high (60th to &amp;amp;lt;80th percentile), or very high (\u226580th percentile) COI or SVI.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi230049-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The main outcome was parent or caregiver report of a physician\u2019s diagnosis of childhood asthma (yes or no). Poisson regression models estimated asthma incidence rate ratios (IRRs) associated with COI and SVI scores at each life stage.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi230049-9\"><jats:title>Results<\/jats:title><jats:p>The study included 10\u202f516 children (median age at follow-up, 9.1 years [IQR, 7.0-11.6 years]; 52.2% male), of whom 20.6% lived in neighborhoods with very high COI and very low SVI. The overall asthma incidence rate was 23.3 cases per 1000 child-years (median age at asthma diagnosis, 6.6 years [IQR, 4.1-9.9 years]). High and very high (vs very low) COI at birth, infancy, or early childhood were associated with lower subsequent asthma incidence independent of sociodemographic characteristics, parental asthma history, and parity. For example, compared with very low COI, the adjusted IRR for asthma was 0.87 (95% CI, 0.75-1.00) for high COI at birth and 0.83 (95% CI, 0.71-0.98) for very high COI at birth. These associations appeared to be attributable to the health and environmental and the social and economic domains of the COI. The SVI during early life was not significantly associated with asthma incidence. For example, compared with a very high SVI, the adjusted IRR for asthma was 0.88 (95% CI, 0.75-1.02) for low SVI at birth and 0.89 (95% CI, 0.76-1.03) for very low SVI at birth.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi230049-10\"><jats:title>Conclusions<\/jats:title><jats:p>In this cohort study, high and very high neighborhood opportunity during early life compared with very low neighborhood opportunity were associated with lower childhood asthma incidence. These findings suggest the need for future studies examining whether investing in health and environmental or social and economic resources in early life would promote health equity in pediatric asthma.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapediatrics.2023.3133","type":"journal-article","created":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T15:32:52Z","timestamp":1693236772000},"page":"1055","source":"Crossref","is-referenced-by-count":50,"title":["Neighborhood Opportunity and Vulnerability and Incident Asthma Among Children"],"prefix":"10.1001","volume":"177","author":[{"given":"Izzuddin M.","family":"Aris","sequence":"first","affiliation":[{"name":"Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Perng","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora"},{"name":"Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Dabelea","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora"},{"name":"Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora"},{"name":"Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy M.","family":"Padula","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akram","family":"Alshawabkeh","sequence":"additional","affiliation":[{"name":"Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen M.","family":"V\u00e9lez-Vega","sequence":"additional","affiliation":[{"name":"University of Puerto Rico (UPR) Graduate School of Public Health, UPR Medical Sciences Campus, San Juan, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy L.","family":"Aschner","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey"},{"name":"Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Carlos A.","family":"Camargo","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Harvard T.H. 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