Childhood Asthma, Healthcare Access, and the Urban Neighborhood in St. Louis, Missouri

Asthma is the most prevalent chronic childhood disease and disproportionately affects minority children in poverty. While several studies have examined the relationship between asthma prevalence and urban locality, continued examination of the relationship between the built environment and asthma are needed.  St. Louis’ high asthma rates, position in the Rust Belt, and continued suburbanization and concentration of poverty near the urban core, make it worthy of analysis.  Using data from sources including the Missouri Information Community Assessment, the Missouri Spatial Data Information Service, and the U.S. Department of Housing and Urban Development, Geographic Information Systems was used to determine asthma prevalence across 30 zip codes in the St. Louis Metropolitan area.  Hotspot analysis was used to identify asthma “hotspots” and determine spatial associations between high asthma rates, socio-demographic and neighborhood characteristics (i.e., race, income, crime, public housing, and deteriorating housing), and access to healthcare resources (i.e., physicians and asthma medication). Results revealed a “hotspot” of high asthma rates in north St. Louis city and, in contrast, a “hotspot” for low asthma rates in south St. Louis city.  Socio-demographic and neighborhood characteristics of high asthma “hotspots” differed from those areas of low asthma prevalence.  Areas of high asthma had largely minority populations living in or near poverty and had greater concentrations of public housing, deteriorating housing, and violence.  Moreover, physical access to healthcare resources was limited in high asthma areas.  Implications include expansion of access to healthcare resources and consideration of neighborhoods when addressing asthma disparities in urban areas.