Pediatric asthma emergency department (ED) visits are higher among young children with asthma who live in areas with lower opportunities, including social/economic and educational neighborhood opportunities, researchers reported in the Journal of Allergy and Clinical Immunology.
The cross-sectional study assessed population-level associations between place-based social determinants of health (SDOHs), as measured with the Child Opportunity Index (COI), and asthma morbidity among children younger than 5 years of age, based on at-risk rates (ARRs) for ED and hospitalization encounters, by census tract, in Washington, DC.
Study participants were identified from the DC Pediatric Asthma Registry between January 1, 2018, and December 31, 2019, and all ED encounters and hospitalizations during the same 2-year period were also identified for analysis.
The COI was used to measure place-based SDOHs for each DC census tract. The overall COI 2.0 includes 29 SDOHs, with 2010 and 2015 data from multiple sources. The study authors evaluated scores (1-100) for the overall COI and its 3 domains (educational, health/environmental, and social/economic) as exposure variables.
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Shifting the focus to improving community-level SDOHs, particularly social, economic, and educational opportunities, may reduce asthma-related morbidity in early childhood.
A total of 3806 children living in 131 census tracts were included. The children had a mean (SD) age of 2.4 (1.4) years, 60% were male, 78% were publicly insured, and 53% had been prescribed an asthma controller medication.
Of the cohort, 2132 children (56%) had 5852 ED encounters in the previous 24 months; 1326 children (35%) had more than 1 ED encounter, with a median of 2 (interquartile range [IQR], 1-3) ED encounters per child. A total of 1418 hospitalizations occurred in 821 children (22%) in the previous 24 months.
The mean census tract population with asthma was 29 (23) children. ARRs for ED ranged from 362 to 3439 encounters per 1000 children aged younger than 5 years of age with asthma, with a mean of 1379 (445) and a median of 1337 (IQR, 1133-1642). ARRs for hospitalization ranged from 121 to 797 encounters per 1000 children younger than 5 years of age with asthma, with a mean of 360 (99) and a median of 339 (IQR, 308-398).
Simple linear regression (SLR) showed that an increased overall COI had a significant association with a reduction in ED ARRs (regression coefficient [RC]: –11; standard error (SE): 1.23; P <.0001). Comparable significant and negative associations were found regarding the educational (RC: –8.6: SE: 1.42; P <.001), health/environmental (RC: –5.7; SE: 1.5; P =.0002), and social/economic (RC: –10.4; SE: 1.18; P <.001) domains.
An increase in overall COI (RC: –7.8; SE: 1.97; P =.0001) and the educational domain (RC: –3.9; SE: 1.58; P =.02) and social/economic domain (RC: –7.7; SE: 1.91; P <.0001) remained significantly associated with reduced ED ARRs in multivariable linear regression analysis.
A 1-point increase in the overall, social/economic, or educational COI was correlated with a respective reduction of 7.8, 7.7, and 3.9 in ED encounters per 1000 children younger than 5 years of age with asthma. No exposure variables or covariates had a significant association with hospitalization ARRs in the SLR.
Among several limitations, small census tract asthma populations resulted in omission of 25% of census tracts from the analysis. In addition, fewer hospitalizations occurred during the study period compared with ED encounters. Furthermore, additional factors, including asthma severity, medication/health care access, and individual social needs, were not assessed.
“Shifting the focus to improving community-level SDOHs, particularly social, economic, and educational opportunities, may reduce asthma-related morbidity in early childhood,” the researchers stated.
