Housing code violations are marker for asthma risk

VANCOUVER, B.C. – Pediatricians and public health professionals can estimate children’s asthma risk based on the density of housing code violations in their neighborhood, according to a retrospective cohort study reported at the annual meeting of the Pediatric Academic Societies.

Investigators led by Dr. Andrew F. Beck, of the pediatrics department at Cincinnati Children’s Hospital Medical Center, calculated the density of asthma-relevant housing code violations – those for cockroaches, rodents, mold, and water damage – for 113 neighborhoods (census tracts) in the Greater Cincinnati area.

Analyses showed that this density was significantly and positively associated with the neighborhood’s rate of pediatric asthma-related emergency department (ED) visits and hospital admissions.

Also, among the subset of patients who were admitted for asthma, the odds of another ED visit or admission in the next year increased with the density of violations. It was elevated by more than 50% for those living in neighborhoods with a medium-high or high density of violations relative to those living in neighborhoods with a low density.

"A measure of housing code violation density ... was found to be significantly correlated with asthma utilization rates at the population level, and significantly and independently associated with reutilization at the patient level," Dr. Beck commented.

"In an era where home visits are rare, local geographic data that highlight the impact of context on health provide a virtual home or neighborhood visit. Such information could help to identify upstream areas where disparity reduction can be targeted within care delivery, a focus especially relevant for diseases like asthma that are heavily impacted by the quality of one’s surroundings," he maintained.

"We expect that local risk-specific data can influence delivery of public health services more proactively. For example, the pairing of housing data with outcome data could facilitate identification of geographic areas likely to benefit from targeted housing assessments and actions," Dr. Beck added. "We also believe that contextual housing data can be integrated into clinical care. Such information could rapidly inform and drive focused interventions for connections to housing experts; for example, patients could be more efficiently connected to social workers, home health providers, and community partners such as legal advocates and community health workers, all of whom may be more suited to handling underlying housing risks than the medical team."

Study results showed that across neighborhoods, the median density of asthma-relevant housing code violations was 11 per 1,000 homes and apartments, with a range from 0 to 120, according to Dr. Beck.

The investigators identified 8,736 asthma-related ED visits and admissions to Cincinnati Children’s Hospital Medical Center by children aged 1-16 years during the study period. As the neighborhood density of housing code violations increased, so did this rate (r = 0.59; P less than .0001).

Moreover, the association remained significant after adjustment for neighborhood poverty level. Overall, the density of violations accounted for 25% of the variation across neighborhoods in such asthma-related health care use.

Among 1,531 pediatric patients with an index hospital admission for asthma, 37% had another ED visit or admission during a year of follow-up.

In a multivariate analysis, the adjusted odds of such repeat use increased with the neighborhood housing code violation density. Relative to peers living in neighborhoods with low density, children living in ones with medium-high density or high density had a significantly elevated risk (odds ratios, 1.54 and 1.84, respectively).

"In our region, housing assessments are complaint-driven; thus, the true breadth of violations is unknown," Dr. Beck noted, addressing study limitations. Also, generalizability is unclear; "we expect that many jurisdictions, however, collect similar data and use that data in similar ways."

Dr. Beck disclosed no relevant conflicts of interest.

VANCOUVER, B.C. – Pediatricians and public health professionals can estimate children’s asthma risk based on the density of housing code violations in their neighborhood, according to a retrospective cohort study reported at the annual meeting of the Pediatric Academic Societies.

Investigators led by Dr. Andrew F. Beck, of the pediatrics department at Cincinnati Children’s Hospital Medical Center, calculated the density of asthma-relevant housing code violations – those for cockroaches, rodents, mold, and water damage – for 113 neighborhoods (census tracts) in the Greater Cincinnati area.

Analyses showed that this density was significantly and positively associated with the neighborhood’s rate of pediatric asthma-related emergency department (ED) visits and hospital admissions.

Also, among the subset of patients who were admitted for asthma, the odds of another ED visit or admission in the next year increased with the density of violations. It was elevated by more than 50% for those living in neighborhoods with a medium-high or high density of violations relative to those living in neighborhoods with a low density.

"A measure of housing code violation density ... was found to be significantly correlated with asthma utilization rates at the population level, and significantly and independently associated with reutilization at the patient level," Dr. Beck commented.

"In an era where home visits are rare, local geographic data that highlight the impact of context on health provide a virtual home or neighborhood visit. Such information could help to identify upstream areas where disparity reduction can be targeted within care delivery, a focus especially relevant for diseases like asthma that are heavily impacted by the quality of one’s surroundings," he maintained.

"We expect that local risk-specific data can influence delivery of public health services more proactively. For example, the pairing of housing data with outcome data could facilitate identification of geographic areas likely to benefit from targeted housing assessments and actions," Dr. Beck added. "We also believe that contextual housing data can be integrated into clinical care. Such information could rapidly inform and drive focused interventions for connections to housing experts; for example, patients could be more efficiently connected to social workers, home health providers, and community partners such as legal advocates and community health workers, all of whom may be more suited to handling underlying housing risks than the medical team."

Study results showed that across neighborhoods, the median density of asthma-relevant housing code violations was 11 per 1,000 homes and apartments, with a range from 0 to 120, according to Dr. Beck.

The investigators identified 8,736 asthma-related ED visits and admissions to Cincinnati Children’s Hospital Medical Center by children aged 1-16 years during the study period. As the neighborhood density of housing code violations increased, so did this rate (r = 0.59; P less than .0001).

Moreover, the association remained significant after adjustment for neighborhood poverty level. Overall, the density of violations accounted for 25% of the variation across neighborhoods in such asthma-related health care use.

Among 1,531 pediatric patients with an index hospital admission for asthma, 37% had another ED visit or admission during a year of follow-up.

In a multivariate analysis, the adjusted odds of such repeat use increased with the neighborhood housing code violation density. Relative to peers living in neighborhoods with low density, children living in ones with medium-high density or high density had a significantly elevated risk (odds ratios, 1.54 and 1.84, respectively).

"In our region, housing assessments are complaint-driven; thus, the true breadth of violations is unknown," Dr. Beck noted, addressing study limitations. Also, generalizability is unclear; "we expect that many jurisdictions, however, collect similar data and use that data in similar ways."

Dr. Beck disclosed no relevant conflicts of interest.

VANCOUVER, B.C. – Pediatricians and public health professionals can estimate children’s asthma risk based on the density of housing code violations in their neighborhood, according to a retrospective cohort study reported at the annual meeting of the Pediatric Academic Societies.

Investigators led by Dr. Andrew F. Beck, of the pediatrics department at Cincinnati Children’s Hospital Medical Center, calculated the density of asthma-relevant housing code violations – those for cockroaches, rodents, mold, and water damage – for 113 neighborhoods (census tracts) in the Greater Cincinnati area.

Analyses showed that this density was significantly and positively associated with the neighborhood’s rate of pediatric asthma-related emergency department (ED) visits and hospital admissions.

Also, among the subset of patients who were admitted for asthma, the odds of another ED visit or admission in the next year increased with the density of violations. It was elevated by more than 50% for those living in neighborhoods with a medium-high or high density of violations relative to those living in neighborhoods with a low density.

"A measure of housing code violation density ... was found to be significantly correlated with asthma utilization rates at the population level, and significantly and independently associated with reutilization at the patient level," Dr. Beck commented.

"In an era where home visits are rare, local geographic data that highlight the impact of context on health provide a virtual home or neighborhood visit. Such information could help to identify upstream areas where disparity reduction can be targeted within care delivery, a focus especially relevant for diseases like asthma that are heavily impacted by the quality of one’s surroundings," he maintained.

"We expect that local risk-specific data can influence delivery of public health services more proactively. For example, the pairing of housing data with outcome data could facilitate identification of geographic areas likely to benefit from targeted housing assessments and actions," Dr. Beck added. "We also believe that contextual housing data can be integrated into clinical care. Such information could rapidly inform and drive focused interventions for connections to housing experts; for example, patients could be more efficiently connected to social workers, home health providers, and community partners such as legal advocates and community health workers, all of whom may be more suited to handling underlying housing risks than the medical team."

Study results showed that across neighborhoods, the median density of asthma-relevant housing code violations was 11 per 1,000 homes and apartments, with a range from 0 to 120, according to Dr. Beck.

The investigators identified 8,736 asthma-related ED visits and admissions to Cincinnati Children’s Hospital Medical Center by children aged 1-16 years during the study period. As the neighborhood density of housing code violations increased, so did this rate (r = 0.59; P less than .0001).

Moreover, the association remained significant after adjustment for neighborhood poverty level. Overall, the density of violations accounted for 25% of the variation across neighborhoods in such asthma-related health care use.

Among 1,531 pediatric patients with an index hospital admission for asthma, 37% had another ED visit or admission during a year of follow-up.

In a multivariate analysis, the adjusted odds of such repeat use increased with the neighborhood housing code violation density. Relative to peers living in neighborhoods with low density, children living in ones with medium-high density or high density had a significantly elevated risk (odds ratios, 1.54 and 1.84, respectively).

"In our region, housing assessments are complaint-driven; thus, the true breadth of violations is unknown," Dr. Beck noted, addressing study limitations. Also, generalizability is unclear; "we expect that many jurisdictions, however, collect similar data and use that data in similar ways."

Dr. Beck disclosed no relevant conflicts of interest.