Social risk factors for pediatric asthma exacerbations: A systematic review

Abstract

AbstractObjectiveThis systematic review aims to identify social risk factors that influence pediatric asthma exacerbations.MethodsCohort studies published between 2010 and 2020 were systematically searched on the OVID Medline, Embase, and PsycInfo databases. Using our established phased inclusion and exclusion criteria, studies that did not address a pediatric population, social risk factors, and asthma exacerbations were excluded. Out of a total of 707 initially retrieved articles, 3 prospective cohort and 6 retrospective cohort studies were included.ResultsUpon analysis of our retrieved studies, two overarching domains of social determinants, as defined by Healthy People 2030, were identified as major risk factors for pediatric asthma exacerbations: Social/Community Context and Neighborhood/Built Environment. Social/Community factors including African American race and inadequate caregiver perceptions were associated with increased risk for asthma exacerbations. Patients in high-risk neighborhoods, defined by lower levels of education, housing, and employment, had higher rates of emergency department readmissions and extended duration of stay. Additionally, a synergistic interaction between the two domains was found such that patients with public or no health insurance and residence in high-risk neighborhoods were associated with excess hospital utilization attributable to pediatric asthma exacerbations.ConclusionSocial risk factors play a significant role in influencing the frequency and severity of pediatric asthma exacerbations.3-Question Summary Box:1. What is the current understanding of this subject?The individual impact of social factors such as insurance, neighborhood, and ethnicity on pediatric asthma exacerbations has previously been explored.2. What does this report add to the literature?This review systematically identifies the relative importance of individual sociodemographic factors and interactions between them. Race, neighborhood risk, insurance status, caregiver perceptions, and a synergistic interaction between health insurance status and neighborhood risk were found to be contributary.3. What are the implications for public health practice?It is important for providers to educate patients on how their surroundings impact their respiratory health and advocate for increased healthcare access for at-risk populations.