Social needs associated with poor asthma control among under-resourced children
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Key takeaways:
- Social needs are immediate needs articulated by individuals.
- Caregivers requested assistance for a median of two social needs.
- Adjusted odds for asthma control fell by 30% with each social need reported.
Individual and aggregate social needs were associated with poor asthma control among a population of predominantly under-resourced children, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.
Patient-centered approaches that identify and address these needs should be part of pediatric asthma care, Rachel H.F. Margolis, PhD, research postdoctoral fellow, Center for Translational Research, Children’s National Hospital, and colleagues wrote.
“The IMPACT DC Asthma Clinic began routinely administering a paper social needs checklist at the beginning of each clinic visit in order to connect families with resources,” Margolis told Healio.
“While the relationship between social risk factors — such as substandard housing quality, material hardship, etc — and asthma morbidity is well established, with our clinical data, we had the unique opportunity to examine the relationship between social issues that families prioritized and asthma control,” she continued.
The researchers defined social needs as immediate needs articulated by individuals. By asking families with asthma about their social needs, the researchers said, the focus shifts to factors that are most important to them.
The study involved 356 caregivers of under-resourced children aged 4 to 18 years (mean age, 8.26 years; 59% boys; 79.2% Black) with poorly controlled asthma evaluated at the Pediatric Asthma Care Clinic in the District of Columbia between Jan. 2, 2019, and March 12, 2020.
Nearly two-thirds of the children (n = 233; 65.4%) had uncontrolled asthma, defined by an Asthma Control Test score of less than 20. Also, 84.5% had persistent asthma, and 15.5% had intermittent asthma.
The researchers further noted that 93.3% of the children were on public insurance.
Caregivers were asked to indicate what they would like help with on an eight-item checklist, including:
- “I would like to get help with providing food for my family.
- I have trouble paying my utility bills.
- I need help finding job training or employment programs.
- I want to apply for public benefits.
- My family needs diapers or baby supplies.
- I have concerns about my child’s asthma at school.
- My family is experiencing issues with household asthma triggers.”
- I need help with another social need.
Overall, caregivers requested help with a median of two social needs (interquartile range [IQR], 3-1; range, 1-8). The patients with uncontrolled asthma had a median of two social needs as well, but the patients with controlled asthma had a median of one (P = .004).
The most common needs included household asthma triggers (42.7%), providing food (37.1%), paying utility bills (33.7%), job training and employment programs (29.5%) and concerns about asthma at school (26.8%).
“The burden of needs was quite substantial,” Margolis said.
Compared with patients with controlled asthma, patients with uncontrolled asthma were significantly more likely to request help for household asthma triggers (47% vs. 34.7%; P = .03) and for asthma at school (30.3% vs. 20.2%; P = .04).
There also was an association between household asthma triggers and lower odds for asthma control (adjusted OR = 0.6; 95% CI, 0.37-0.98) but not between asthma at school and asthma control (aOR = 0.64; 95% CI, 0.37-1.12).
Additionally, adjusted odds for asthma control fell by 30% with each one-unit increase in social need count (aOR = 0.7; 95% CI, 0.57-0.86).
“We were interested to find that a higher count of social needs was associated with lower odds for asthma control,” Margolis said.
Considering these associations between greater social need burdens and lower odds for asthma control, the researchers said their findings highlight the importance of routinely identifying and addressing these needs during asthma care to improve outcomes and reduce socioeconomic, racial and health disparities.
“Our study is the first to demonstrate a relationship between the additive burden of social needs and asthma morbidity,” Margolis said.
The researchers also called for innovative methods that asthma clinics could use to address these needs in addition to further analysis of the impact that these methods would have on asthma control and other markers of asthma morbidity.
Changes in policy may have an impact as well, Margolis said.
“First and foremost, we need policies that expand access to healthy and affordable housing,” she said.
“Second, given our finding that aggregate social needs are associated with poor asthma control, any policy that reduces social needs — whether it’s expanding food stamps (SNAP) or increasing utility bill assistance — could theoretically improve asthma outcomes,” she continued.
Meanwhile, the researchers are continuing their work.
“We are conducting qualitative research to examine the family’s experience with social needs screening in the asthma clinic, including whether their needs were addressed by the resources/referrals provided,” Margolis said. “We are also working on expanding routine social needs screening for asthma patients across our institution.”
Perspective
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Andrea Pappalardo, MD, FAAAAI, FACAAI
These findings are significant. What we experience every day influences our asthma. While this seems obvious, when we concentrate on the more abstract influences, we often lose sight of what is critically important to living with asthma for many of our families who live in communities where so much is outside of their own control.
This is my everyday experience with families. I work in mobile asthma clinics within Chicago communities at schools to improve access to asthma subspecialists and at a public safety net hospital that serves adults and children across Illinois. I hear about the everyday influences in each encounter. Our next course in the asthma management we forge together is intricately intertwined with their immediate social needs. If I and others do not do this, we will never achieve long-lasting asthma control.
Talk to your patients and understand that life is dynamic, and as they continue in their asthma journey, play an active role in ensuring all of the influencing factors are adequately addressed.
Dilapidated housing, landlords who do not care for the properties that many of our families have no choice but to rent, and food insecurity are ongoing concerns in which policy solutions can be crafted to help reduce these social needs, which in turn improves chronic disease.
How best to craft screening tools, motivational interviewing skills of clinicians, stable and shared resources, and implementation of critical social policies that influence asthma are future areas we can facilitate through research transformation within addressing social needs of the families we care for every day.
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