CHAM-led Study Is First Ever to Link Air Pollution Levels with Longer Hospital Stays for Children with Asthma

During a summer when poor air quality alerts left many families worried about their children’s respiratory health, a new study from Children’s Hospital at Montefiore (CHAM) has found a link between higher air pollution and longer hospital stays for children with asthma in the Bronx.

While asthma is a leading cause of pediatric hospitalization nationwide, its prevalence among Bronx children—a staggering 17%—is nearly three times the national average. Socioeconomic factors and home environmental triggers, like highway pollution, mold and pests can also increase asthma risk.

“We know that the Bronx has poor air quality and has been in violation of federal air quality standards,” said Elissa B. Gross, DO, MPH, Attending Physician, Hospital Medicine, Children’s Hospital at Montefiore, and Assistant Professor, Clinical Pediatrics, Albert Einstein College of Medicine, who led a team of investigators for the study titled “Childhood Asthma in the Bronx, NY; the Impact of Pollutants on Length of Hospital Stay,” which was published in June in the Journal of Asthma. “Given climate change and worsening air quality in general, asthma has the potential to become even more of a problem in the Bronx.”

Longer hospital stays have far-reaching consequences in the communities Montefiore Einstein serves. Parents and guardians often lose income, and potentially risk their job security, to stay at their children’s bedside. “It’s not just healthcare costs,” Gross said, “it’s also the socioeconomic costs—and it’s traumatizing.”

For the study, Gross led a team of Montefiore Einstein investigators to analyze the medical records of more than 1,900 children ages 2 to 18 who were admitted to CHAM for asthma-related symptoms between 2017 and 2019. Those admitted on days with high levels of fine particulate matter (PM 2.5) in the air experienced longer hospital stays. The same findings applied to children admitted one day after high levels of recorded pollution from ground-level ozone (O₃), a greenhouse gas.

The data point to an average 10% longer stay for every 10 micrograms of pollutants per cubic meter of air. “While 10% may seem like a very small margin, for each point it goes up, it gets amplified,” Gross said. A 50-microgram per cubic meter increase in pollution could turn a two-day hospital stay into three.

When a child’s symptoms improve and they can safely head home from the hospital, Montefiore Einstein’s family-centered approach ensures parents and caregivers have the education they need prior to the patient’s discharge. Children with asthma who are hospitalized at CHAM are often referred for outpatient care through the Asthma Treatment Program, a multidisciplinary clinic that makes pediatric pulmonology and allergy treatment more accessible to Bronx families.

Call 718-741-2450 to make an appointment with the Pediatric Asthma Center at CHAM.