The Role of Neighborhood Opportunity in Early Childhood Asthma and Differences by Urbanicity

Abstract

IntroductionAsthma is a prevalent chronic condition among children in the United States, with children in Washington state accounting for 20% of the state’s estimated 600,000 asthma cases. Neighborhood environments during the sensitive developmental period of infancy can influence respiratory health, yet their role in the etiology of childhood asthma remains underexplored. The Childhood Opportunity Index (COI) offers a comprehensive measure of neighborhood-level structural, environmental, and socioeconomic factors. This study examined associations between COI scores during infancy with early childhood (4-6 years) asthma and wheeze, and whether these associations varied by urbanicity. Methods We analyzed data from 457 children enrolled in the ECHO PATHWAYS-GAPPS cohort across two Washington state sites: Seattle and Yakima. Neighborhood opportunity was assessed using COI scores categorized into very low/low, moderate, and high/very high opportunity; sensitivity analyses used continuous scores scaled to the interquartile range (IQR). Asthma and wheeze outcomes were measured at the 4-6 year child visit via caregiver-reported validated questionnaires. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Models were adjusted for child sex, maternal race/ethnicity, maternal education, maternal age at delivery, maternal history of asthma, study site, and household smoker. An interaction model tested for effect modification by urbanicity (recruitment site). Results Of the 457 participants, 207 caregivers were recruited from birthing centers at a hospital in Yakima and 250 from two Seattle hospitals. Most children (n=365; 79.9%) lived in neighborhoods classified as moderate and high/very high opportunity. Asthma and wheeze were reported in 11.5% and 12.6% of participants, respectively. No statistically significant associations were observed between overall COI and either outcome. Domain-specific analyses did not reveal strong associations, though estimates generally indicated increased odds of asthma and wheeze as neighborhood opportunity improved. No evidence of effect modification by urbanicity was found for asthma (p=0.519) and wheeze (p=0.802). Conclusions Neighborhood opportunity during infancy was not found to be associated with asthma or wheeze in early childhood (ages 4-6 years), and associations did not vary by urbanicity. Patterns of elevated odds in more opportune environments may reflect greater access to healthcare and caregiver engagement with diagnostic resources, rather than true differences in disease burden. Findings diverge from prior literature, highlighting the complexity of neighborhood influences on early respiratory health.