IMPORTANCEIn the United States, Black and Hispanic children have higher rates of asthma and asthma-related morbidity compared with White children and disproportionately reside in communities with economic deprivation.OBJECTIVE To determine the extent to which neighborhood-level socioeconomic indicators explain racial and ethnic disparities in childhood wheezing and asthma. DESIGN, SETTING, AND PARTICIPANTSThe study population comprised children in birth cohorts located throughout the United States that are part of the Children's Respiratory and Environmental Workgroup consortium. Cox proportional hazard models were used to estimate hazard ratios (HRs) of asthma incidence, and logistic regression was used to estimate odds ratios of early and persistent wheeze prevalence accounting for mother's education, parental asthma, smoking during pregnancy, child's race and ethnicity, sex, and region and decade of birth.EXPOSURES Neighborhood-level socioeconomic indicators defined by US census tracts calculated as z scores for multiple tract-level variables relative to the US average linked to participants' birth record address and decade of birth. The parent or caregiver reported the child's race and ethnicity.MAIN OUTCOMES AND MEASURES Prevalence of early and persistent childhood wheeze and asthma incidence. RESULTSOf 5809 children, 46% reported wheezing before age 2 years, and 26% reported persistent wheeze through age 11 years. Asthma prevalence by age 11 years varied by cohort, with an overall median prevalence of 25%. Black children (HR, 1.47; 95% CI, and Hispanic children (HR, 1.29; 95% CI, 1.09-1.53) were at significantly increased risk for asthma incidence compared with White children, with onset occurring earlier in childhood. Children born in tracts with a greater proportion of low-income households, population density, and poverty had increased asthma incidence. Results for early and persistent wheeze were similar. In effect modification analysis, census variables did not significantly modify the association between race and ethnicity and risk for asthma incidence; Black and Hispanic children remained at higher risk for asthma compared with White children across census tracts socioeconomic levels. CONCLUSIONS AND RELEVANCEAdjusting for individual-level characteristics, we observed neighborhood socioeconomic disparities in childhood wheeze and asthma. Black and Hispanic children had more asthma in neighborhoods of all income levels. Neighborhood-and individual-level characteristics and their root causes should be considered as sources of respiratory health inequities.

Objective Systemic sclerosis–related pulmonary hypertension (SSc‐PH) is a common complication of SSc associated with accelerated mortality. The present study was undertaken to investigate whether cardiac axis deviation indicates abnormalities in cardiac function allowing for prognostication of disease severity and mortality. Methods This was a retrospective study in which electrocardiograms (ECGs) were reviewed for cardiac axis deviation and their association with echocardiography and cardiopulmonary hemodynamics on right‐sided heart catheterization. The primary outcome observed was all‐cause mortality from the time of PH diagnosis. Results ECG results were reviewed from 169 patients with SSc‐PH. Right axis deviation (RAD) and left axis deviation (LAD) occurred in 28.4% and 30.8% of patients with SSc‐PH, respectively. Compared to those without RAD, patients with RAD exhibited predominantly right‐sided cardiac disease on echocardiography and increased PH severity by cardiopulmonary hemodynamics including a greater mean ± SD pulmonary artery pressure (42.0 ± 12.5 mm Hg versus 29.8 ± 7.0 mm Hg) and mean ± SD pulmonary vascular resistance (645.6 ± 443.2 dynes · seconds/cm5 versus 286.3 ± 167.7 dynes · seconds/cm5). LAD was associated with predominantly left‐sided cardiac disease on echocardiography but was not associated with PH severity on cardiopulmonary hemodynamics. Both RAD (hazard ratio 10.36 [95% confidence interval 4.90–21.93], P < 0.001) and LAD (hazard ratio 2.94 [95% confidence interval 1.53–5.68], P = 0.001) were associated with an increased hazard for all‐cause mortality. Conclusion RAD and LAD reflect structural cardiac abnormalities and are associated with poor prognosis in patients with SSc‐PH. These findings support the importance of electrocardiography, an inexpensive, widely available noninvasive test, in risk stratification.

Patients with systemic sclerosis complicated by both pulmonary hypertension (SSc‐PH) and interstitial lung disease (SSc‐PH‐ILD) have poor prognosis compared to those with SSc‐PH or SSc‐ILD alone. Little is known of how ILD severity affects outcomes in those with SSc‐PH, or how PH severity affects outcomes in those with SSc‐ILD. Herein, we aimed to delineate clinical features of patients with SSc‐PH and SSc‐ILD and determine to what degree PH and ILD severity contribute to mortality in patients with SSc. We conducted parallel retrospective studies in cohorts of patients with SSc‐PH and SSc‐ILD. We categorized ILD severity by pulmonary function testing and PH severity by cardiopulmonary hemodynamics. Our primary outcome was all‐cause mortality from time of PH or ILD diagnosis for the SSc‐PH and SSc‐ILD cohorts, respectively. We calculated adjusted risks of time to all‐cause mortality using Cox proportional hazards models. In patients with SSc‐PH, severe ILD (HR: 3.54; 95% CI: 1.05, 11.99) was associated with increased hazards for all‐cause mortality. By contrast, mild and moderate ILD were not associated with increased mortality risk. In patients with SSc‐ILD, both moderate (HR: 2.65; 95% CI: 1.12, 6.31) and severe PH (HR: 6.60; 95% CI: 2.98, 14.61) were associated with increased hazards for all‐cause mortality, while mild PH was not. Through our parallel study design, the risk of all‐cause mortality increases as severity of concomitant ILD or PH worsens. Therapies that target slowing disease progression earlier in the disease course may be beneficial.

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