The Interplay of Pollution, Child Opportunity, and High Health Care Utilization in Children With Asthma in San Diego County.

Objectives: This study aims to (1) compare air pollution and child opportunity between neighborhoods with and without high health care utilization (HHU) for asthma, and (2) compare health care utilization frequency by race, ethnicity, primary language, and insurance type at the patient level.

Methods: This retrospective cohort study examined children with asthma within the Rady Children's Health System (2015-2020) who met HHU criteria [≥2 emergency department (ED) visits in 6 months or ≥2 hospitalizations in 12 mo]. Patient addresses were geocoded to census tracts, and ArcGIS was used to map CalEnviroScore 4.0 and the Child Opportunity Index. Descriptive statistics assessed health care utilization differences based on patient demographics.

Results: This study included 1070 individuals. The median HHU asthma rate was 1.7 per 1000 children (interquartile range: 0.9 to 3.1) across 408 census tracts. Pollution burden was significantly higher in tracts with HHU asthma cases than those without ( P = 0.002). Census tracts with HHU asthma cases had lower Child Opportunity Index scores compared with those without ( P < 0.001). Black patients had more ED visits than white patients ( P = 0.002). Hispanic patients had more inpatient hospitalizations than non-Hispanics ( P = 0.043). Medicaid/Medi-Cal patients had more ED and inpatient encounters than those with commercial insurance ( P = 0.001).

Conclusions: We identified disparities in pollution and child opportunity among pediatric asthma patients with HHU. These differences are linked to race, ethnicity, and insurance type. These findings can guide efforts to improve child health equity.