Respiratory Emergencies in Pediatrics: Associations in Redlining, Air Quality and Traffic Regulation The REPARATION Study during COVID-19

David Hibbert; Tom Beucler; Karyssa N Domingo; Sydney Leibel

doi:10.1007/s40615-025-02741-x

Respiratory Emergencies in Pediatrics: Associations in Redlining, Air Quality and Traffic Regulation The REPARATION Study during COVID-19

J Racial Ethn Health Disparities. 2025 Nov 13. doi: 10.1007/s40615-025-02741-x. Online ahead of print.

Authors

David Hibbert^{1

2}, Tom Beucler³, Karyssa N Domingo⁴, Sydney Leibel^{5

6}

Affiliations

¹ Department of Internal Medicine, UC San Diego, 200 W Arbor Dr, San Diego, CA, 92103, USA. dhibbert132@gmail.com.
² Unisanté, Rue du Bugnon 44, 1011, Lausanne, VD, Switzerland. dhibbert132@gmail.com.
³ Faculty of Geosciences and Environment, University of Lausanne, 1015, Lausanne, VD, Switzerland.
⁴ School of Medicine, UC San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
⁵ Department of Pediatrics, Division of Allergy/Immunology, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
⁶ Rady Children's Hospital, 3020 Children's Way, San Diego, CA, 92123, USA.

PMID: 41233670
DOI: 10.1007/s40615-025-02741-x

Abstract

Background: The COVID-19 stay-at-home order created a temporary period of reduced air pollution in San Diego County, offering a natural experiment to assess how cleaner air affects pediatric respiratory health. Historical housing discrimination through redlining has left lasting environmental and health inequities, particularly for non-White and low-income communities.

Objective: To evaluate whether children in socially vulnerable or historically redlined neighborhoods experienced greater reductions in respiratory emergency department (ED) visits during the COVID-19 lockdown.

Methods: We conducted a retrospective study of 101,733 pediatric ED encounters (2016-2020) at Rady Children's Hospital. Weekly respiratory visits encounter rates during weeks 10-15 of 2020 were compared to the 2016-2019 baseline. ZIP code-level social vulnerability was measured using the CDC Social Vulnerability Index (SVI), and historical redlining grades from the Home Owners' Loan Corporation (HOLC) were spatially linked to the ED data. Correlations and Welch's t-tests assessed associations between respiratory visit changes, SVI quintiles, and HOLC grades.

Results: Respiratory ED visits declined by 0.25-1.4 visits per week across ZIP codes during the lockdown, with the greatest reductions observed in areas with high Minority Status and Language SVI scores (p 0.001). Historically redlined (HOLC grade D) neighborhoods overlapped with high-SVI areas and showed significantly greater vulnerability (p 0.001).

Conclusions: Cleaner air during the COVID-19 lockdown corresponded with fewer pediatric respiratory emergencies, especially in historically marginalized neighborhoods. These findings highlight how structural inequities continue to influence respiratory health and emphasize the need for equitable pollution-reduction policies.

Keywords: Air pollution; COVID-19 pandemic; Environmental justice; Pediatric respiratory health; Redlining; Social Vulnerability Index; Structural racism.