Article Text

Download PDFPDF

Violent crime and socioeconomic deprivation in shaping asthma-related pollution susceptibility: a case-crossover design
  1. Perry E Sheffield1,
  2. Jessie L C Shmool2,
  3. Ellen J Kinnee3,
  4. Jane E Clougherty4
  1. 1 Environmental Medicine and Public Health and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  2. 2 Department of Environmental and Occupational Health, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
  3. 3 University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  4. 4 Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Perry E Sheffield, Environmental Medicine and Public Health and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA; perry.sheffield{at}


Background The objective of this study was to quantify and compare the relative influence of community violent crime and socioeconomic deprivation in modifying associations between ozone and emergency department (ED) visits for asthma among children.

Methods We used a spatiotemporal case-crossover analysis for all New York City EDs for the months May–September from 2005 to 2011 from a statewide administrative ED dataset. The data included 11 719 asthmatic children aged 5–18 years, and the main outcome measure was percentage of excess risk of asthma ED visit based on Cox regression analysis.

Results Stronger ozone–asthma associations were observed for both elevated crime and deprivation (eg, on lag day 2, we found 20.0% (95% CI 10.2% to 30.6 %) and 21.0% (10.5% to 32.5%) increased risk per 10 ppb ozone, for communities in the highest vs lowest quartiles of violent crime and deprivation, respectively). However, in varied models accounting for both modifiers, only violence retained significance.

Conclusions The results suggest stronger spatiotemporal ozone–asthma associations in communities of higher violent crime or deprivation. Notably, violence was the more consistent and significant modifier, potentially mediating a substantial portion of socioeconomic position–related susceptibility.

  • air pollution
  • violence
  • asthma
  • paediatric
  • poverty

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors PES, JLCS and JEC conceptualised the study. All authors contributed to the conduct and reporting of the work. All authors commented on drafts and read and approved the final manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. PES is the guarantor.

  • Funding National Institute of Environmental Health Sciences (R21ES021429; K23ES024127 (PES)); U.S. Environmental Protection Agency (EPA) (RD-83457601 (JEC, JLCS)); NHLBI (4R01HL114536 (JEC, EJK)).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Program for Protection of Human Subjects at Icahn School of Medicine at Mount Sinai (HS no. 12-00322) and University of Pittsburgh.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.