Wang Veronica A, Habre Rima, Ryan Patrick H, Datta Soma, Luttmann-Gibson Heike, Blossom Jeff, Aris Izzuddin M, Chandran Aruna, Kress Amii M, Gilliland Frank, Breton Carrie, Farzan Shohreh F, Camargo Carlos A, Liang Donghai, Kerver Jean M, Karr Catherine J, Leve Leslie D, Dabelea Dana, Karagas Margaret R, Bennett Deborah H, Nkoy Flory L, Aschner Judy, O'Shea T Michael, McEvoy Cindy T, Knapp Emily A, Schuh Holly B, Miller Rachel L, Gold Diane R, Zanobetti Antonella
Environmental Health, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
University of Southern California Keck School of Medicine, Los Angeles, California, USA.
BMJ Open. 2025 Jun 30;15(6):e094317. doi: 10.1136/bmjopen-2024-094317.
Access to healthy and affordable foods may play a role in reducing inflammation and in healthy pulmonary immune system development.
To investigate the association between residing in a low-income and low-food-access (LILA) neighbourhood and risk of childhood asthma. A positive association was hypothesised.
DESIGN, SETTING AND PARTICIPANTS: This prospective cohort study consists of 16 012 children from 35 longitudinal studies in the Environmental influences on Child Health Outcomes programme (children born 1998-2021) from across the contiguous USA. We conducted survival analyses adjusted for child sex, race/ethnicity, maternal education, gestational smoking, and parental history of asthma.
Several commonly used geospatial food access metrics were linked to residential locations including: LILA census tracts where the nearest supermarket is >1 mile in urban and >10 miles in rural areas (LILA), >1 mile in urban and >20 miles in rural areas (LILA), >0.5 mile in urban and >10 miles in rural areas (LILA), and >0.5 mile without a vehicle or >20 miles (LILA). Each metric was linked to lifetime residential history timelines then dichotomised according to whether the child had spent at least 75% of their life living in a LILA area separately for birth through age 5 years (cumulative early childhood) and birth through age 11 years (cumulative middle childhood).
Asthma incidence in cumulative early and middle childhood.
Residing in a LILA and LILAneighbourhood was associated with a higher asthma incidence in cumulative early and middle childhood. The LILA and LILA associations were stronger for asthma during cumulative early childhood, where we observed hazard ratios of 1.13 (95% CI 1.02 to 1.24) and 1.13 (95% CI 1.01 to 1.27), respectively. The associations were higher among children who were Hispanic, were female and had lower maternal education.
Limited residential food access was associated with higher childhood asthma incidence, especially among female and Hispanic children and those with lower maternal education. Our findings support multipronged efforts to increase access to healthy and affordable food options and lower food insecurity in LILA neighbourhoods.
获取健康且价格合理的食物可能在减轻炎症以及促进肺部免疫系统健康发育方面发挥作用。
调查居住在低收入且食物获取不便（LILA）社区与儿童哮喘风险之间的关联。假设存在正相关。
设计、背景与参与者：这项前瞻性队列研究由来自美国本土35项纵向研究的16012名儿童组成，这些研究属于“环境对儿童健康结果的影响”项目（1998 - 2021年出生的儿童）。我们进行了生存分析，并对儿童性别、种族/族裔、母亲教育程度、孕期吸烟情况以及父母哮喘病史进行了调整。
几种常用的地理空间食物获取指标与居住地点相关联，包括：在城市中距离最近超市超过1英里且在农村超过10英里的LILA普查区（LILA）、在城市中超过1英里且在农村超过20英里的区域（LILA）、在城市中超过0.5英里且在农村超过10英里的区域（LILA），以及在没有车辆的情况下超过0.5英里或超过20英里的区域（LILA）。每个指标都与终生居住历史时间线相关联，然后根据儿童在出生至5岁（幼儿期累计）以及出生至11岁（童年中期累计）期间是否至少75%的时间生活在LILA区域进行二分法划分。
幼儿期累计和童年中期累计的哮喘发病率。
居住在LILA和LILA社区与幼儿期累计和童年中期累计的哮喘发病率较高相关。在幼儿期累计阶段，LILA和LILA的关联更强，在此阶段我们分别观察到风险比为1.13（95%置信区间1.02至1.24）和1.13（95%置信区间1.01至1.27）。在西班牙裔、女性以及母亲教育程度较低的儿童中，这种关联更高。
有限的居住区域食物获取与儿童哮喘发病率较高相关，尤其是在女性、西班牙裔儿童以及母亲教育程度较低的儿童中。我们的研究结果支持多方面努力，以增加在LILA社区获取健康且价格合理食物的机会，并降低食物不安全状况。
