Environmental and socioeconomic influences on childhood asthma and pneumonia: burden and healthcare utilization in a population-based cohort study

Abstract

Introduction Childhood asthma and pneumonia remain major causes of pediatric morbidity worldwide. Their occurrence and healthcare burden are influenced by environmental exposures, socioeconomic conditions, and seasonal variability. Objective This study evaluated the disease burden, associated risk factors, and healthcare utilization patterns among children with asthma and/or pneumonia. Methods A retrospective cohort study was conducted using pediatric electronic medical records from Wuhu Hospital, Anhui Province, China, covering January 2022 to December 2025. The study included 936 children aged 1–14 years with confirmed diagnoses of asthma, pneumonia, or both conditions. Environmental exposure data, including nitrogen dioxide (NO2), particulate matter (PM2.5), temperature, and humidity, were obtained from regional monitoring systems. Socioeconomic status was determined using census-based indicators. Multivariable logistic regression was performed to identify factors associated with hospitalization. Results Among the 936 children, 47.4% had asthma, 36.5% had pneumonia, and 16.0% had both conditions. Lower socioeconomic status was strongly associated with pneumonia, whereas asthma occurred across all socioeconomic groups. Higher ambient NO2 and PM2.5 concentrations were significantly associated with asthma, while biomass fuel use and poor household ventilation were linked to pneumonia. Pneumonia incidence peaked during winter, whereas asthma cases increased in spring. Children with pneumonia experienced higher hospitalization rates and longer hospital stays, while asthma was associated with more frequent emergency department visits and outpatient consultations. Recurrent asthma episodes occurred in 44.1% of affected children. Discussion Childhood asthma and pneumonia impose a substantial healthcare burden, with distinct environmental, socioeconomic, and seasonal determinants. Strategies aimed at reducing air pollution exposure, improving household air quality through cleaner fuels and better ventilation, and addressing socioeconomic barriers to healthcare access may help reduce disease burden and improve pediatric respiratory health.