Child Opportunity Index Mobility, Recurrent Wheezing, and Asthma in Early Childhood: A Population-Based Prospective Cohort Study
Year: 2025
Type: conference-abstract
Abstract: Examine the relationship between early childhood place-based opportunity, as measured by the Child Opportunity Index (COI), and the risk of recurrent wheeze and asthma by age 3 years.The study included children in New York from 2008 to 2010 who were part of a prior prospective, observational birth cohort originally used to study the effects of maternal fertility treatment on child health. Children conceived with and without fertility treatment were included in a 1:3 ratio. Inclusion criteria included singletons or 1 randomly selected twin. Lack of residential address geocoded to the COI, information on covariates, and consistent response to wheeze/asthma survey questions were excluded.This study was a secondary analysis of a prospective, observational birth cohort. Two exposures were investigated: COI at birth and COI mobility during childhood using the COI 2.0 quintiles from 2010. COI was assigned based on residential address at birth through 3 years. Outcomes included parent-reported recurrent wheeze or physician-diagnosed asthma by 3 years.Of the 4458 children included, 449 (10.1%) reported recurrent wheeze by 3 years. Among the 3029 children with available asthma data, 147 (4.9%) had physician-diagnosed asthma between ages 18 and 36 months. The breakdown of COI in the population studied was very high 30.1%, high 28.6%, moderate 20.5%, low 10.9%, and very low 10%. Upward COI mobility was observed in 9% of children, whereas 7% experienced downward mobility. Very high COI at birth was associated with decreased recurrent wheeze (odds ratio [OR] 0.66; CI 0.49, 0.88), and downward COI mobility was not associated with significant risk reduction in recurrent wheeze. For physician-diagnosed asthma between ages 18 and 36 months, (i) very high COI at birth was associated with reduced odds of developing asthma (adjusted OR [aOR] 0.59; CI 0.35, 0.96), (ii) downward COI mobility was associated with increased odds of asthma development (aOR 2.11; CI 1.18, 3.55), and (iii) adjusting for private insurance attenuated that increased risk (aOR 0.59; CI 0.35, 0.96).Risk of physician-diagnosed asthma by age 3 years, but not recurrent wheeze, was associated with downward COI mobility, suggesting that place and environment play a larger role in asthma development over transient wheeze. This association was attenuated when adjusting for private insurance, used as a family-level proxy for socioeconomic status, suggesting that family resources also impact odds of developing asthma by 3 years. Very high COI at birth was associated with lower risk of asthma and recurrent wheeze, although upward mobility from lower quintiles did not demonstrate decreased risk, which the authors suspect is due to low sample size.The development of wheeze in early childhood and possible transition to asthma is not well understood. There are few studies that have investigated the association of place-based opportunity (via COI) in early childhood and wheeze/asthma. Although this study has its limitations (small samples sizes for specific cohort subsets, lack of diversity, controversy of asthma diagnoses <5 years), results suggest that environmental differences in early childhood (<3 years) can affect the risk of asthma development. Acknowledging that COI mobility may not occur as evidenced by the low overall percentage of mobility in this study (9% upward, 10% downward), findings support the need for further investigation of feasibly modifiable risk factors at this early age and raise the question of potential underlying mechanisms at play (eg, epigenetic changes) that may be targetable in the future.
Source: PEDIATRICS
Authors: Patricia C. dela Cruz, J. Andrew Bird
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4416832480
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