Children born in lower-opportunity neighborhoods may face higher incidence rates of asthma with recurrent exacerbations, NIH study finds

Children born in neighborhoods with fewer opportunities are more likely to experience repeated asthma flares requiring emergency care or medical treatment, with non-Hispanic Black children having the highest incidence rates of asthma with recurrent exacerbations, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

Asthma with recurring exacerbations (AREs) is a more severe form of childhood asthma linked to worsened health, high medical costs, and significant challenges for both the patient and their family, especially compared to well-controlled asthma. ARE affects many children in the U.S., with about 6 and a half cases per 1,000 children per year in the nationwide ECHO program.

Neighborhood factors—such as access to housing, healthy food, transportation, and education—can impact childhood asthma development. The Child Opportunity Index (COI) is one measure used to assess these conditions, connecting residential addresses at different early-life stages to data on neighborhood resources. This index combines information from 29 factors, such as access to good schools, healthy food, parks, clean air, and job opportunities. Studies have shown that neighborhoods with higher COI scores tend to have better conditions that help children grow up healthier and have more opportunities for economic success.

ECHO researchers used the COI to analyze how these factors influenced the development of this severe type of childhood asthma. The study included data from 15,877 children born between 1990 and 2018 across 60 ECHO study sites in the U.S.

“This study suggests that individual- and neighborhood-level exposures may affect the risk for developing childhood ARE,” said Rachel Miller, MD, of the Icahn School of Medicine at
Mount Sinai.

Researchers found that:

• Children from low-opportunity neighborhoods had significantly higher incidence rates of asthma with recurrent exacerbations (ARE) than those from higher-opportunity areas.
• Non-Hispanic Black children had the higher rates across all neighborhood categories when compared to non-Hispanic White children.
• Among children in very low-opportunity neighborhoods, non-Hispanic Black and Hispanic Black children had rates of ARE several times higher than non-Hispanic White children.
• Young children (ages 2 to 4) and those with a parent who had asthma had a higher risk of ARE.

What happened during the study

In this study, researchers followed children from ages 2 to at least 5, and up to age 19. They collected information on asthma diagnoses and the use of corticosteroids, a medication that helps reduce inflammation in the body. ARE was identified if a child used corticosteroids at least twice during the follow-up period while being monitored by ECHO researchers.

The study also examined the link between COI scores and children's birth addresses. Researchers analyzed how neighborhood conditions influenced the development of asthma with recurrent exacerbations while accounting for individual health history and other factors.

“This study adds to the mounting evidence that investing in neighborhood resources may have a myriad of respiratory health benefits for children,” said Dr. Miller.   

Additional studies could help researchers further understand the prenatal and early childhood determinants of ARE at both the individual and neighborhood levels.

This collaborative research was published in the Journal of Allergy and Clinical Immunology.

About ECHO
The ECHO Cohort Consortium is a research program supported by the National Institutes of Health (NIH) with the mission to enhance the health of children for generations to come. ECHO Cohort investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

Miller, R. and Johnson, C. Child Opportunity Index at Birth and Asthma with Recurrent Exacerbations in the U.S. ECHO Program. Journal of Allergy and Clinical Immunology, DOI: 10.1016/j.jaci.2025.02.036