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Assessment of neighbourhood-level socioeconomic status as a modifier of air pollution–asthma associations among children in Atlanta
  1. Cassandra R O'Lenick1,
  2. Andrea Winquist1,
  3. James A Mulholland2,
  4. Mariel D Friberg2,
  5. Howard H Chang3,
  6. Michael R Kramer4,
  7. Lyndsey A Darrow4,
  8. Stefanie Ebelt Sarnat1
  1. 1Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  2. 2School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
  3. 3Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  4. 4Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  1. Correspondence to Cassandra R O'Lenick, Emory University, Second Floor, Claudia Nance Rollins Building, Rm. 2030 B, 1518 Clifton Road NE, Atlanta, GA 30322, USA; croleni{at}


Background A broad literature base provides evidence of association between air pollution and paediatric asthma. Socioeconomic status (SES) may modify these associations; however, previous studies have found inconsistent evidence regarding the role of SES.

Methods Effect modification of air pollution–paediatric asthma morbidity by multiple indicators of neighbourhood SES was examined in Atlanta, Georgia. Emergency department (ED) visit data were obtained for 5–18 years old with a diagnosis of asthma in 20-county Atlanta during 2002–2008. Daily ZIP Code Tabulation Area (ZCTA)-level concentrations of ozone, nitrogen dioxide, fine particulate matter and elemental carbon were estimated using ambient monitoring data and emissions-based chemical transport model simulations. Pollutant–asthma associations were estimated using a case-crossover approach, controlling for temporal trends and meteorology. Effect modification by ZCTA-level (neighbourhood) SES was examined via stratification.

Results We observed stronger air pollution–paediatric asthma associations in ‘deprivation areas’ (eg, ≥20% of the ZCTA population living in poverty) compared with ‘non-deprivation areas’. When stratifying analyses by quartiles of neighbourhood SES, ORs indicated stronger associations in the highest and lowest SES quartiles and weaker associations among the middle quartiles.

Conclusions Our results suggest that neighbourhood-level SES is a factor contributing vulnerability to air pollution-related paediatric asthma morbidity in Atlanta. Children living in low SES environments appear to be especially vulnerable given positive ORs and high underlying asthma ED rates. Inconsistent findings of effect modification among previous studies may be partially explained by choice of SES stratification criteria, and the use of multiplicative models combined with differing baseline risk across SES populations.

  • Environmental epidemiology

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