Environmental exposures such as traffic may contribute to asthma morbidity including recurrent emergency department (ED) visits. However, these associations are often confounded by socioeconomic status and health care access. This study aims to assess the association between traffic density and recurrence of asthma ED visits in the primarily low income Medicaid population in New York State (NYS) between 2005 and 2015. The primary outcome of interest was a recurrent asthma ED visit within 1-year of index visit. Traffic densities (weighted for truck traffic) were spatially linked based on home addresses. Bivariate and multivariate logistic regression analyses were conducted to identify factors predicting recurrent asthma ED visits. In a multivariate model, Medicaid recipients living within 300-m of a high traffic density area were at a statistically significant risk of a recurrent asthma ED visit compared to those in a low traffic density area (OR = 1.31; 95% CI:1.24,1.38). Additionally, we evaluated effect measure modification for risk of recurrent asthma visits associated with traffic exposure by socio-demographic factors. The highest risk was found for those exposed to high traffic and being male (OR = 1.87; 95% CI:1.46,2.39), receiving cash assistance (OR = 2.11; 95% CI:1.65,2.72), receiving supplemental security income (OR = 2.21; 95% CI:1.66,2.96) and being in the 18.44 age group (OR = 1.59;95% CI 1.48,1.70) was associated with the highest risk of recurrent asthma ED visit. Black non-Hispanics (OR = 2.35; 95% CI:1.70,3.24), Hispanics (OR = 2.13; 95% CI:1.49,3.04) and those with race listed as “Other” (OR = 1.89 95% CI:1.13,3.16) in high traffic areas had higher risk of recurrent asthma ED visits as compared to White non-Hispanics in low traffic areas. We observed significant persistent disparities in asthma morbidity related to traffic exposure and race/ethnicity in a low-income population. Our findings suggest that even within a primarily low-income study population, socioeconomic differences persist. These differences in susceptibility in the extremely low-income group may not be apparent in health studies that use Medicaid enrollment as a proxy for low SES.

中文翻译：

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2005-2015 年纽约州 Medicaid 参保者的道路交通密度和哮喘急诊就诊次数

交通等环境暴露可能导致哮喘发病率，包括经常性急诊 (ED) 就诊。然而，这些关联常常被社会经济地位和医疗保健服务所混淆。本研究旨在评估 2005 年至 2015 年间纽约州 (NYS) 主要低收入医疗补助人群的交通密度与哮喘急诊就诊复发之间的关联。感兴趣的主要结果是 1 年内哮喘急诊就诊复发索引访问。交通密度（卡车交通加权）基于家庭地址在空间上联系起来。进行双变量和多变量逻辑回归分析以确定预测哮喘复发就诊的因素。在多元模型中，与交通密度低的地区相比，居住在交通密度高的地区 300 米范围内的医疗补助接受者发生哮喘急诊就诊的风险具有统计学意义（OR = 1.31；95% CI：1.24,1.38）。此外，我们通过社会人口因素评估了与交通暴露相关的哮喘复发风险的效果测量修正。那些暴露于高流量和男性（OR = 1.87；95% CI：1.46,2.39）、接受现金援助（OR = 2.11；95% CI：1.65,2.72）、接受补充安全收入（ OR = 2.21；95% CI：1.66,2.96）和处于 18.44 岁年龄组（OR = 1.59；95% CI 1.48,1.70）与哮喘复发就诊的最高风险相关。非西班牙裔黑人（OR = 2.35；95% CI：1.70,3.24），西班牙裔（OR = 2.13；95% CI：1.49,3。04）和那些在人流量大的地区被列为“其他”种族的人（OR = 1.89 95% CI：1.13,3.16）与在人流量少的地区的非西班牙裔白人相比，哮喘复发的风险更高。我们观察到低收入人群中与交通暴露和种族/民族相关的哮喘发病率存在显着的持续差异。我们的研究结果表明，即使在主要是低收入研究人群中，社会经济差异仍然存在。在使用 Medicaid 登记作为低 SES 的代表的健康研究中，极低收入群体的这些易感性差异可能并不明显。我们观察到低收入人群中与交通暴露和种族/民族相关的哮喘发病率存在显着的持续差异。我们的研究结果表明，即使在主要是低收入研究人群中，社会经济差异仍然存在。在使用 Medicaid 登记作为低 SES 的代表的健康研究中，极低收入群体的这些易感性差异可能并不明显。我们观察到低收入人群中与交通暴露和种族/民族相关的哮喘发病率存在显着的持续差异。我们的研究结果表明，即使在主要是低收入研究人群中，社会经济差异仍然存在。在使用 Medicaid 登记作为低 SES 的代表的健康研究中，极低收入群体的这些易感性差异可能并不明显。