Question: Please tell us a bit about yourself and your connection to this work.

Dr. Visness: I’m Cindy Visness, a collaborating author on the asthma study we will talk about. I work at Rho, a global, full-service contract research organization (CRO) with a proven track record of drug development success. Rho has supported more than 50 asthma trials over the past three decades. I have been a research scientist at Rho since 2008.

Since joining the Rho team, I’ve conducted various respiratory disease research studies, with a focus on asthma and allergies. Currently, I am the lead scientist for the Childhood Asthma in Urban Settings (CAUSE) Network, which is part of the National Institute of Allergy and Infectious Diseases’ (NIAID) Division of Allergy, Immunology and Transplant (DAIT). One of our most notable CAUSE studies is the Urban Environment and Childhood Asthma (URECA) study. It helped identify risk factors for developing asthma and allergic disease in early life. The study spans four research sites and includes around 600 families.

Recently, the prevalence of allergic and respiratory diseases has increased greatly. We don’t know the causes, but it may be related to a combination of lifestyle choices and environmental pollutants. My years of experience studying these factors combined with my passion for children and families have driven me to continue advancing our understanding of allergic and respiratory illnesses and providing better access to proper care and treatments for people with asthma and other illnesses.

Question: Please talk about the study, “Childhood Asthma Incidence, Early and Persistent Wheeze, and Neighborhood Socioeconomic Factors in the ECHO/CREW Consortium.”

Dr. Visness: The study looked at 5,809 children across the U.S. in various birth cohorts (groups of people born during a particular period), including the URECA cohort. We wanted to better estimate the odds of wheezing early in childhood. These measurements looked at:

• Mother’s education level
• Mother’s history of asthma
• If the mother smoked during pregnancy
• Child’s race/ethnicity, sex, location, and birth date
  
  

Our team also reviewed public socioeconomic census data to help us understand both neighborhood and individual qualities that might affect respiratory health inequities.

Question: What were the results of the study?

Dr. Visness: The combined analysis showed that children born in areas with a higher population and a greater number of low-income households and poverty have a higher risk of developing asthma. Also, Black and Hispanic children have higher hazard ratios of asthma than white children.

Including the census data in the analysis did not change the relationship between race, ethnicity, and asthma. Across all socioeconomic levels, Black and Hispanic children were still at a higher risk for asthma. Of the 5,809 children in this trial:

• 46% reported wheezing before they turned 2 years old
• 26% reported persistent wheezing until age 11
  
  

Researchers came to a similar conclusion for early and persistent wheeze.

Question: What does this study mean for children and families living with asthma and groups like AAFA that are working toward eliminating the asthma health disparities affecting racial and ethnic minorities?

Dr. Visness: The study found large disparities in socioeconomic indicators in the United States Census Bureau data with Black and Hispanic children more likely to live in neighborhoods with a denser population and higher rates of poverty. At the same time, children born in areas with higher poverty and lower household income were at higher risk for childhood wheezing and developing asthma.

But race and ethnicity were still a risk factor for asthma after considering neighborhood income. This shows that Black and Hispanic children are at a higher risk than white children for developing asthma across all neighborhoods.

Multiple factors may play a role in this higher risk. They include:

• Systemic and individual racism
• Segregation
• Poverty
• Health care access
  
  

Future research in this field can guide interventions and policies, enacted at local levels, to improve health among people disproportionately exposed to and affected by the environments in which they live.

Question: Is there anything else you would like to share about the study?

Dr. Visness: Observational studies, including the birth cohort studies involved in CREW and ECHO, provide important clues about the effects individual and environmental factors can have on disease outcomes. The biological samples collected in these studies give additional context on the impact of these factors.

The “holy grail” in pediatric asthma research is to find an intervention that could prevent allergic diseases and asthma – that could stop the atopic march in its tracks. Rho is working closely with sponsors to figure out how the immune system reacts to various exposures and stimuli through observational studies and clinical trials. This would allow us to get closer to finding treatments or interventions that could prevent disease from developing or getting worse.

Question: What is the ECHO/CREW Consortium?

Dr. Visness: The Children’s Respiratory and Environment Workgroup (CREW) is an association made up of 12 birth cohorts and more than 6,000 research participants. It was created to examine risk factors for asthma and allergic disease in early childhood development.

CREW is one of the 35 U.S. awardee groups in the pediatric cohort of the Environmental Influences on Child Health Outcomes (ECHO) program. This program looks at how a range of environmental factors impacts the health of children and adolescents.

CREW has 35 awards, 84 birth cohorts, more than 50,000 children and diverse research initiatives examining areas of asthma/allergy, obesity, neurodevelopment, and more. Rho is working with the participating organizations to contribute data, find solutions on how to better match data, and participate in multiple analysis projects.

Question: Who was involved in the study?

Dr. Visness: Rho collaborated with the University of Wisconsin-Madison leaders of the CREW consortium and acted as the coordinating center for CREW. The analyses were performed at the Department of Environmental Health at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts, under the direction of Dr. Antonella Zanobetti. Each participating cohort had investigators, study coordinators, data managers, and lab personnel involved at each research site.