Dynamic associations of neighborhood social and physical environment with ED visits for asthma: A spatial change score analysis

Background: A growing number of studies identified risk factors for asthma in neighborhood social and environmental contexts. Yet, there is a lack of comprehensive knowledge about the time-varying relationship between neighborhood environmental and socioeconomic factors and asthma outcomes. Objectives: This study aimed to assess the variations in neighborhood environmental, socioeconomic, and demographic characteristics; to investigate the census tracts in Los Angeles County where emergency department (ED) visits for asthma increased; and to identify neighborhood characteristics whose change contributed to alleviating or exacerbating the burden of asthma in health care use. Methods: Using an ecological, retrospective study design, we applied a change score method, spatial regression and geographic information system analysis to examine time-varying effects of neighborhood characteristics in Los Angeles County. Results: and ED visits for asthma was validated by the spatial pattern analysis. Conclusions: as a neighborhood environmental risk factor for asthma. However, little evidence was found for the beneficial effect of improved neighborhood socioeconomic status. Our findings underscore that, in the short term, reducing traffic emissions may contribute more to lowering the burden of asthma-related health care use than improving neighborhoods' socioeconomic status.