注：本文由小咖机器人翻译整理

期刊来源：JAMA

文献发表时间：2023-05-16

原文链接：https://jamanetwork.com/journals/jama/article-abstract/2804823

关键点内容如下：

问题

旨在纠正住房歧视的住房流动计划是否能降低城市高贫困社区儿童的哮喘发病率？

调查结果

在这项123哮喘儿童的队列研究中，参与者在搬家前每人年的急性发作次数为0.88次，而搬家后每人年的急性发作次数为0.40次，差异显著。

意义

儿童的家庭参与了一项帮助他们搬到低贫困社区的计划，这些儿童的哮喘发病率得到了显著改善。

摘要内容如下：

重要性

结构性种族主义与生活在城市弱势社区的儿童所经历的不成比例的高哮喘发病率有关。目前旨在减少哮喘诱因的方法影响不大。

目标

研究参与住房流动计划是否与降低儿童哮喘发病率有关，并探讨潜在的中介因素。该计划提供住房券和向低贫困社区提供援助。

研究对象

2016年至2020年，123名5至17岁患有持续性哮喘的儿童的队列研究，这些儿童的家庭参加了巴尔的摩地区住房伙伴关系住房流动计划。使用倾向评分将115名儿童与城市环境与儿童哮喘（URECA）出生队列中的115名儿童进行匹配。

干预措施

搬到低贫困社区。

主要成果

护理人员报告哮喘加重和症状。

结果

在参加该项目的123儿童中，平均年龄为8.4岁，58人（47.2%）为女性，120人（97.6%）为黑人。在迁移之前，110名儿童中有89名（81%）生活在高度贫困的人口普查区（超过20%的家庭生活在贫困线以下）；搬迁后，106名有搬迁后数据的儿童中只有1名（0.9%）生活在高贫困区。在这个队列中，15.1%的（SD，35.8%的）在搬家前每3个月至少有1次恶化，而8.5%的（SD，28.0%的）在搬家后，调整后的差异为-6.8个百分点（95%CI，-11.9%至-1.7%；P=.009）。

过去2周的最大症状天数为移动前5.1（SD，5.0）和移动后2.7（SD，3.8），调整后的差异为-2.37天（95%CI，-3.14至-1.59；P<.001）。在与URECA数据的倾向评分匹配分析中，结果仍然显著。压力的测量，包括社会凝聚力、邻里安全和城市压力，都随着搬家而改善，并且估计在搬家和哮喘恶化之间的关联中起到29%到35%的中介作用。

结论和相关性

哮喘儿童的家庭参加了一项帮助他们搬到低贫困社区的计划，他们的哮喘症状天数和恶化情况得到了显著改善。这项研究补充了有限的证据，表明反对住房歧视的计划可以降低儿童哮喘的发病率。

英文原文如下：

Key Points

Question  Does a housing mobility program designed to remedy housing discrimination reduce asthma morbidity among children from urban, high-poverty neighborhoods?

Findings  In this cohort study of 123 children with asthma, participants experienced 0.88 exacerbations per person-year in the period before moving vs 0.40 exacerbations per person-year after moving, a significant difference.

Meaning  Children whose families participated in a program that helped them move into low-poverty neighborhoods experienced significant improvements in asthma morbidity.

Abstract

Importance  Structural racism has been implicated in the disproportionally high asthma morbidity experienced by children living in disadvantaged, urban neighborhoods. Current approaches designed to reduce asthma triggers have modest impact.

Objective  To examine whether participation in a housing mobility program that provided housing vouchers and assistance moving to low-poverty neighborhoods was associated with reduced asthma morbidity among children and to explore potential mediating factors.

Design, Setting, and Participants  Cohort study of 123 children aged 5 to 17 years with persistent asthma whose families participated in the Baltimore Regional Housing Partnership housing mobility program from 2016 to 2020. Children were matched to 115 children enrolled in the Urban Environment and Childhood Asthma (URECA) birth cohort using propensity scores.

Exposure  Moving to a low-poverty neighborhood.

Main Outcomes  Caregiver-reported asthma exacerbations and symptoms.

Results  Among 123 children enrolled in the program, median age was 8.4 years, 58 (47.2%) were female, and 120 (97.6%) were Black. Prior to moving, 89 of 110 children (81%) lived in a high-poverty census tract (>20% of families below the poverty line); after moving, only 1 of 106 children with after-move data (0.9%) lived in a high-poverty tract. Among this cohort, 15.1% (SD, 35.8) had at least 1 exacerbation per 3-month period prior to moving vs 8.5% (SD, 28.0) after moving, an adjusted difference of −6.8 percentage points (95% CI, −11.9% to −1.7%; P = .009). Maximum symptom days in the past 2 weeks were 5.1 (SD, 5.0) before moving and 2.7 (SD, 3.8) after moving, an adjusted difference of −2.37 days (95% CI, −3.14 to −1.59; P < .001). Results remained significant in propensity score–matched analyses with URECA data. Measures of stress, including social cohesion, neighborhood safety, and urban stress, all improved with moving and were estimated to mediate between 29% and 35% of the association between moving and asthma exacerbations.

Conclusions and Relevance  Children with asthma whose families participated in a program that helped them move into low-poverty neighborhoods experienced significant improvements in asthma symptom days and exacerbations. This study adds to the limited evidence suggesting that programs to counter housing discrimination can reduce childhood asthma morbidity.