title: Areas with High Rates of Police-Reported Violent Crime Have Higher Rates of Childhood Asthma Morbidity.
abstract: To assess whether population-level violent (and all) crime rates were associated with population-level child asthma utilization rates and predictive of patient-level risk of asthma reutilization after a hospitalization.
  
  
  
  A retrospective cohort study of 4638 pediatric asthma-related emergency department visits and hospitalizations between 2011 and 2013 was completed. For population-level analyses, census tract asthma utilization rates were calculated by dividing the number of utilization events within a tract by the child population. For patient-level analyses, hospitalized patients (n = 981) were followed until time of first asthma-related reutilization. The primary predictor was the census tract rate of violent crime as recorded by the police; the all crime (violent plus nonviolent) rate was also assessed.
  
  
  
  Census tract-level violent and all crime rates were significantly correlated with asthma utilization rates (both P < .0001). The violent crime rate explained 35% of the population-level asthma utilization variance and remained associated with increased utilization after adjustment for census tract poverty, unemployment, substandard housing, and traffic exposure (P = .002). The all crime rate explained 28% of the variance and was similarly associated with increased utilization after adjustment (P = .02). Hospitalized children trended toward being more likely to reutilize if they lived in higher violent (P = .1) and all crime areas (P = .01). After adjustment, neither relationship was significant.
  
  
  
  Crime data could help facilitate early identification of potentially toxic stressors relevant to the control of asthma for populations and patients.
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Electronic address: Andrew.Beck1@cchmc.org.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Beck
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Bin
authors.initials: B
authors.lastname: Huang
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Ryan
authors.affiliation: Department of Pediatrics, Boston Medical Center, Boston, MA.
authors.forename: Megan T
authors.initials: MT
authors.lastname: Sandel
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Chen
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kahn
mesh_terms: D001249:Asthma / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003415:Crime / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D000069581:Exposure to Violence / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009820:Ohio / Q000453:epidemiology; D016495:Police; D012189:Retrospective Studies
keywords: Child Health; Geography; Neighborhood; Violence