1. Asthma morbidity and hospital utilization for unscheduled healthcare visits varies significantly (>10-fold differences) across geographic census tracts in Washington, D.C. and suggests location-based interventions may be required to enhance asthma care.
2. Social Determinants of Health (SDOH), namely educational attainment and violent crimes, were the strongest predictors for risk of Emergency Department visits and hospitalizations for acute asthma care.
Evidence Rating Level: 2 (Good)
Study Rundown: Asthma is a common chronic respiratory disease that is a leading cause for unscheduled healthcare visits in children. Unfortunately, asthma-related outcomes and morbidity appear to have significant disparities which disproportionally affect children who are black, hispanic, or experiencing socioeconomic barriers. This study aimed to evaluate the relationship between social determinants of health (SDOH) and asthma-related emergency department (ED) encounters and hospitalization using the D.C. Asthma Registry and American Community Survey from Washington, D.C. in the United States. There was greater than 10-fold variation across census tracts for both ED encounters and hospitalizations, with significant variation in acute health care visits based on geographical location. The study also examined whether SDOH factors such as educational attainment, adults with limited English proficiency, housing vacancy, poverty, violent crime, age, male sex, controller medication prescription, or public insurance influenced the risk of ED or hospitalizations for asthma care. The strongest predictor of acute asthma care in the ED or hospitalization was educational attainment. Other factors associated with ED visits included increased rates of violent crime and presence of controller medication prescription. One important limitation of this study is that it only examined 5 measures of SDOH, whereas other SDOH not addressed in the study may heavily influence asthma outcomes. In general, this study provides compelling evidence that asthma morbidity is heavily influenced by SDOH and highly variable based on geography. Efforts to address SDOH and location-based initiatives may be beneficial to reduce asthma morbidity and need for unscheduled healthcare visits.
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In Depth [Cross-Sectional Study]: This study utilized the D.C. Asthma Registry to identify children aged 2 to 17 years old between 2018-2019 who accessed ED, hospitalization, and critical care encounters during this timeframe. The participants were cross-referenced with the American Community Survey to subdivide the population to geographically align outcomes with the census tract location quadrants. The registry included children across Children’s National Hospital (CNH) centers identified through the use of 3 electronic health records that captures >90% of children in DC with asthma based on current asthma prevalence estimates and the Behavioral Risk Factor Surveillance System. Of 15,492 children with asthma, 4300 children had 7488 ED encounters, 1176 children had 1579 hospitalizations, and 179 children had 223 critical care hospitalizations. Of the SDOH assessed, decreased educational attainment was most significantly associated with elevated risk of ED encounters (risk of 12.1, 95% CI 8.4 to 15.8, p<.001) and hospitalizations (risk estimate 1.2, 95% CI 0.2 to 2.2, p=0.016). Importantly, violent crime was significantly associated with elevated risk of ED encounters (risk estimate 35.3,9 5% CI 10.2 to 60.4, P=0.006), but did not influence the rate of hospitalization.
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