Social Determinants of Health and At-Risk Rates for Pediatric Asthma Morbidity

Author:

Tyris Jordan12,Gourishankar Anand12,Ward Maranda C.2,Kachroo Nikita1,Teach Stephen J.12,Parikh Kavita12

Affiliation:

1. aDepartment of Pediatrics, Children’s National Hospital, Washington, District of Columbia

2. bGeorge Washington University School of Medicine and Health Sciences, Washington, District of Columbia

Abstract

BACKGROUND AND OBJECTIVES Compared with population-based rates, at-risk rates (ARRs) account for underlying variations of asthma prevalence. When applied with geospatial analysis, ARRs may facilitate more accurate evaluations of the contribution of place-based social determinants of health (SDOH) to pediatric asthma morbidity. Our objectives were to calculate ARRs for pediatric asthma-related emergency department (ED) encounters and hospitalizations by census-tract in Washington, the District of Columbia (DC) and evaluate their associations with SDOH. METHODS This population-based, cross-sectional study identified children with asthma, 2 to 17 years old, living in DC, and included in the DC Pediatric Asthma Registry from January 2018 to December 2019. ED encounter and hospitalization ARRs (outcomes) were calculated for each DC census-tract. Five census-tract variables (exposures) were selected by using the Healthy People 2030 SDOH framework: educational attainment, vacant housing, violent crime, limited English proficiency, and families living in poverty. RESULTS During the study period, 4321 children had 7515 ED encounters; 1182 children had 1588 hospitalizations. ARRs varied 10-fold across census-tracts for both ED encounters (64–728 per 1000 children with asthma) and hospitalizations (20–240 per 1000 children with asthma). In adjusted analyses, decreased educational attainment was significantly associated with ARRs for ED encounters (estimate 12.1, 95% confidence interval [CI] 8.4 to 15.8, P <.001) and hospitalizations (estimate 1.2, 95% CI 0.2 to 2.2, P = .016). Violent crime was significantly associated with ARRs for ED encounters (estimate 35.3, 95% CI 10.2 to 60.4, P = .006). CONCLUSION Place-based interventions addressing SDOH may be an opportunity to reduce asthma morbidity among children with asthma.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference58 articles.

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2. Centers for Disease Control and Prevention . Healthcare use data: hospitalizations. Available at: https://www.cdc.gov/asthma/healthcare-use/2018/table_b.html. Accessed August 30, 2021

3. Akinbami LJ , MoormanJE, BaileyC, ; Centers for Disease Control and Prevention. Trends in asthma prevalence, health care use, and mortality in the United States, 2001–2010. Available at: www.cdc.gov/nchs/data/databriefs/db94_tables.pdf#2. Accessed August 30, 2021

4. Creation and validation of a citywide pediatric asthma registry for the District of Columbia [published online ahead of print March 22, 2021];2Shelef;J Asthma,2021

5. Inner-city asthma in childhood;Coleman;Immunol Allergy Clin North Am,2019

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