Asthma Hot Spots in New York Before and During the COVID-19 Pandemic

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Panel A shows Emerging Hot Spot Analysis results for 6 priority counties for the New York State Children’s Asthma Initiative. Zip code-level quarterly emergency department visit rates from 2016 to 2019 were assigned to 1 of 17 different emerging hot-spot-result categories. Persistent hot spots, indicating consistently high levels of asthma activity, were found in Albany, Erie, Monroe, Onondaga, and Westchester counties. Additionally, intensifying hot spots occurred in Monroe and Onondaga Counties. Sporadic hot spots were found in Erie, Monroe, Nassau, Onondaga, and Westchester counties. Diminishing hot spots were found around Hempstead in Nassau County, and a sporadic cold spot was found in northern Westchester County. No significant patterns were found in Dutchess or Orange counties. Panel B depicts Emerging Hot Spot results for 6 priority counties for the NYS Children’s Asthma Initiative during the pandemic. Hot spot patterns similar to the previous time period occurred in Buffalo (Erie County), Rochester (Monroe County), and Syracuse (Onondaga County). However, many areas that were consistent hot spots in the prior period became sporadic. In Orange County, zip code 12746 emerged as a new sporadic hot spot. Lower Erie County gained 3 new hotspots, and the hotspots in Westchester spread to cover 9 more zip codes that are now categorized as sporadic. In Nassau County, the number of hotspots increased from 5 to 9. No cold spots were found during this time period. No significant patterns were detected in Dutchess or Albany Counties. Panel C displays Emerging Hot Spot Analysis results in the 4 mandatory service areas for the New York State Children’s Asthma Initiative: Bronx, Kings (Brooklyn), New York (Manhattan), and Queens counties. Zip code level quarterly emergency department visit rates from 2016 to 2019 have been assigned to 1 of 17 different emerging hot spot result categories. Hot spots and cold spots are divided by regions where no pattern is detected. Persistent cold spots and intensifying cold spots occurred in lower Kings, lower New York, and upper Queens counties. Sporadic cold spots were scattered across lower Richmond (Staten Island), upper Queens, lower New York, and upper Bronx counties. Consecutive cold spots were found in lower Richmond County. Alternatively, sporadic hot spots were detected in upper Richmond, lower Queens, and lower Bronx counties. Meanwhile, diminishing hot spots were seen in upper Kings, upper New York, lower Queens, and lower Bronx counties. Persistent hot spots occurred in lower Queens County. Panel D displays Emerging Hot Spot Analysis results in the 4 mandatory service areas, from 2020 to quarter 2 of 2022. Across New York, Kings, and Queens counties some cold spots that were once consistent, scattered, or intensifying transitioned into a consecutive cold spot pattern. Sporadic hot spots increased over all counties in areas that were once classified as diminishing. An oscillating hot spot emerged in lower Queens County where no significant pattern was previously detected.

Panels A and B show results of Emerging Hot Spot Analysis (Esri) by zip code level for counties outside New York City with a high asthma burden, before and during the COVID-19 pandemic. Hot spots were detected in urban areas, including Albany (Albany County), Buffalo (Erie County), Rochester (Monroe County), Syracuse (Onondaga County), around Hempstead (Nassau County), and around Yonkers (Westchester County). The analyses for Dutchess and Orange counties did not yield significant results in the 2016 to 2019 time period. The analyses for Dutchess and Albany counties did not yield significant results in the 2020 to quarter 2, 2022 time period. Results for Albany County may be affected by missing data caused by a known lag in reporting by area hospitals during the pandemic. A: Emerging Hot Spot Analysis of zip code-level quarterly asthma emergency department visits per 10,000 population in high-asthma-burden counties, New York State, 2016 to 2019. B: Emerging Hot Spot Analysis of zip code-level quarterly asthma emergency department visits per 10,000 population in high-asthma-burden counties, New York State, 2020 to quarter 2, 2022. Panels C and D show results of Emerging Hot Spot Analysis by zip code level and by county for New York City before and during the COVID-19 pandemic. The dark gray lines represent county borders, and the light gray lines represent zip code borders. The area of zip codes in New York City is shaded according to the emerging hot spot result legend. Panel C shows quarterly asthma emergency department visits per 10,000 population in high asthma burden counties, 2016 to 2019. Panel D shows quarterly emergency department visits per 10,000 population in high asthma burden counties, 2020 to quarter 2, 2022.

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Program surveillance identified 13 of 62 counties in New York State with the highest asthma burden. These counties experienced high rates of asthma-related emergency department visits and hospitalizations among people aged 0 to 24 years, or a disproportionately high number of such visits compared to the state’s total. Among the counties with the greatest asthma burden, 9 were designated priority service areas (Albany, Dutchess, Erie, Monroe, Onondaga, Orange, Nassau, Richmond, and Westchester) and 4 were designated as mandatory service areas (Bronx, Kings, New York, and Queens).

Supplemental Figure. New York State Asthma Control Program service areas in counties with the highest asthma burden. The New York State Children’s Asthma Initiative extends to every county in New York, focusing on mandatory and priority service areas comprising 13 of the highest-burden counties.

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