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It is also worth noting that some communities had high factor scores for more than one stressor factor, underscoring the potential for cumulative effects of multiple exposures in those communities.
In separate ecologic regression models for each stressor factor and NO2, on asthma ED visits, we found a significant association only for Factor 1 ('violent crime and physical disorder'); an interquartile range (IQR) increase in Factor 1 was associated with a 3.9% increase in childhood ED visits (p <0.0001).
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This suggests that stressor factors that trigger clinical disease are many with maximum effect attained under synergistic state.
In our ecologic analysis, we illustrated how modification in the NO2-asthma exacerbation association may vary substantively by the selection of social stressors – represented here by our three stressor factors.
Norton et al. (2002) used principal components analysis to evaluate the relative importance of 18 stressors, then used the first six stressor factors (various combinations of the original 18) within a multiple regression model.
While the spatial patterning empirically summarized by stressor factors would likely differ between cities and regions, this reproducible approach may be helpful in developing locally appropriate composite social stressor measures.
To examine potential modification of NO2 effects by stressor factors, we stratified the 34 UHF areas at the median factor score, and sensitivity-tested models stratifying each factor at a score of 0. We identified significant intra-urban variability and spatial autocorrelation within both social stressors and pollutant concentrations (Table 2).
We examined effect modification in the NO2-asthma exacerbation relationship by stressor factors, and found significant (p <0.05) modification only by Factor 2 ('crowding and poor access to resources'); among UHF areas scoring above the median on Factor 2, each 10 ppb increase in area-average NO2 was associated with a 5.5% increase in child asthma ED visit rates.
6, 7 However, this physiological stability can be disrupted by many stressor factors such as exercise and restraint, 8, 9 neuropharmacological agents such as tianeptine (enhancer of serotonin uptake), 10 doxepin (inhibitor of serotonin uptake), 11 or dopaminergic-blocking agents (such as sulpiride, haloperidol).
The divorce or separation item was mostly evenly loaded across all three factors in the remote FA, while for the non-remote FA, it loaded highest on the labour market stressors factor.
From the EFA, we identified suites of spatially-correlated stressors (factors) and derived factor scores for each UHF area.
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