Pediatric Asthma in the Inland Empire: Environmental Burden, Gaps in Preventive Care, and Unmet Needs.

Background: Asthma is the most prevalent chronic illness in children worldwide, contributing to significant morbidity, health care utilization, and economic burden. In the United States, approximately five million children are affected by asthma. This review explores the environmental contexts and lifestyle determinants of pediatric asthma, with a focus on the Inland Empire (IE) region of Southern California. The IE's unique geographic landscape and importance as a major transportation hub highlights its critical role for understanding how both environmental and structural factors exacerbate asthma burden within the pediatric population. Variables such as household income, parental education levels, and lack of community-based asthma programs were explored. Despite significant burdens, the IE remains under-represented in asthma research, contributing to persistent disparity.

Methods: A narrative literature review and regional data analysis were conducted via PubMed, Scopus, and Google Scholar (2000-2025), alongside data from the CDC, CDPH, and American Lung Association. Key words used included "pediatric asthma, Inland Empire, air pollution, asthma disparity, emergency department utilization, socioeconomic status." Inclusion criteria were: (1) studies or reports focusing on pediatric asthma (ages 0-17), (2) articles addressing environmental, socioeconomic, or health care-related risk factors, and (3) research with either national, state-level, or IE-specific data. Exclusion criteria were: (1) articles not in English, adult-only asthma studies, and (3) publications without original data or reference to pediatric asthma burden, management, or outcomes. Titles and abstracts were screened for relevance, and full texts were reviewed when abstracts met inclusion criteria. A total of 61 studies, reports, and data sources met this criterion and were included into this review.

Results: The IE-comprised of San Bernardino (SB) and Riverside Counties- is home to four of the top five most polluted cities in North America. Vehicle emissions and industrial waste are concentrated in the region due to limited air circulation from surrounding mountains that entrap pollutants. Pediatric asthma ED visit rates in SB and Riverside were 60.5% and 59.3%, compared to California's average of 56.7%. Hospitalization rates for children aged 0-4 were also higher in SB (24.4%) compared to the state average (17.3%). The elevated rates among school-aged children underscore the crucial need for interventions aimed at improving air quality, enhancing asthma management, and increasing access to preventive health care.

Conclusions: Pediatric asthma in the IE reflects heightened environmental risks, socioeconomic barriers, and gaps in health care access. Addressing these disparities requires targeted interventions, policies, and region-specific research to enhance long-term management strategies and outcomes for vulnerable pediatric populations.