Social determinants of health (SDOH), including decreased educational attainment, are associated with at-risk rates (ARRs) for emergency department encounter and hospitalization among children with asthma, according to a study published online July 25 in Pediatrics.
Jordan Tyris, M.D., from the Children’s National Hospital in Washington, D.C., and colleagues conducted a population-based cross-sectional study involving children with asthma, aged 2 to 17 years and living in D.C. For each D.C. census tract, emergency department encounter and hospitalization ARRs were calculated. Using the Healthy People 2030 SDOH framework, five census-tract variables (exposures) were selected: educational attainment, vacant housing, violent crime, limited English proficiency, and families living in poverty.
The researchers found that from January 2018 to December 2019, 4,321 children had 7,515 emergency department encounters and 1,182 children had 1,588 hospitalizations. Across census tracts, ARRs varied 10-fold for emergency department encounters and hospitalizations (64 to 728 and 20 to 240 per 1,000 children with asthma, respectively). Reduced educational attainment was significantly associated with ARRs for emergency department encounters and hospitalizations in adjusted analyses. There was a significant association seen for violent crime with ARRs for emergency department encounters.
“We found that ARRs for pediatric asthma morbidity varied among D.C. census tracts and were associated with SDOH,” the authors write. “This foundational information may be useful to inform highly localized interventions addressing SDOH and evaluate their impact on place-based morbidity among children with asthma living in Washington, D.C.”