Paper Information

To evaluate the effect of neighborhood disadvantage on the back-to-school increase in asthma-related emergency department (ED) visits.

Greater levels of neighborhood disadvantage were associated with a greater increase in the rate of asthma-related ED visits when children returned to school. Neighborhood disadvantage may modify the back-to-school increase in asthma exacerbations by increasing the risk of upper respiratory viral infections.

Rates of viral-associated asthma exacerbations typically increase when children return to school after the summer holiday. The effect of neighborhood disadvantage on this back-to-school increase in viral-associated asthma exacerbations is unknown.

Administrative health records were used to define population-based incidence rates of asthma-related ED visits by week and census tract among children aged 5-17 years. Using Bayesian regression models of incidence rates, we evaluated additive interactions between a seven-week back-to-school period (relative to a six-week summer period) and neighborhood disadvantage (e.g., social vulnerability index, SVI).

In census tracts with low social vulnerability (SVI=2), rates of asthma-related ED visits increased by 378 (95% CrI = 358-398) per 100,000 person-years when children went back to school. Relative to the back-to-school increase in tracts with low social vulnerability, in tracts with moderate social vulnerability (SVI=5) there was an excess of 199 asthma-related ED visits per 100,000 person-years (95% CrI = 183-214). Relative to the back-to-school increase in tracts with moderate social vulnerability, in tracts with high social vulnerability (SVI=8), there was an excess of 303 (95% CrI = 268-339) asthma-related ED visits per 100,000 person-years.