Deprivation impacts children, families with asthma in Washington, D.C.

Key takeaways:

• 54% of families reported at least one social need, 29% reported at least two and 7% reported at least three.
• Results indicate a need to tackle social and ecological hazards in addition to medical strategies.

WASHINGTON — Most families of children with asthma in an urban population reported at least one measure of deprivation, most frequently housing issues, according to data presented at ATS 2023.

These findings may have an impact on policy changes that would elevate housing standards and close disparities in pediatric asthma, Parisa Kaviany, MD, FAAP, pediatric pulmonologist, Children’s National Hospital, and colleagues wrote.

“In Washington, D.C., Black children with asthma are disproportionately affected by the high burden of disease-related morbidity, which contributes to health disparities in asthma outcomes,” Kaviany told Healio.

The researchers noted that 16% of Black children in Washington, D.C., have asthma, compared with 3.3% of non-Hispanic white children. Also, the researchers said that Southeast D.C., where poverty and unemployment rates are the highest in the city, has the highest rates of pediatric ED visits for asthma as well.

Study design, results

The researchers distributed a social needs questionnaire to families participating in IMPACT DC, which evaluates and treats children with recent ED visits or hospitalizations as well as children with uncontrolled asthma in Washington, D.C., between February and June 2022. Participants aged older than 4 years also completed the Asthma Control Test (ACT).

“In our IMPACT DC clinic, we had a high volume of requests from families requesting assistance with various needs. In response, the Social Needs Checklist was generated to enhance our ability to provide resources. This study provided the unique opportunity to investigate the spatial relationship between self-identified social needs and pediatric asthma control in Washington, D.C.,” Kaviany said.

The questionnaire assessed seven categories of deprivation: presence of household asthma triggers, asthma concerns at school, finding employment, applying for public benefits, food insecurity, housing assistance and general assistance.

On average, participants were age 7.6 years. Also, 83% were Black, 97% had public insurance and 38% had moderate to severe asthma. Further, 54% (n = 101) reported at least one need, 29% (n = 54) reported at least two needs and 14% (n = 26) reported at least three needs, according to Kaviany.

“More specifically, 25% (n = 47) reported one need, 15% (n = 28) reported two needs, 7% (n = 14) reported three needs, 5% (n = 10) reported four needs, less than 1% (n = 1) reported five needs and less than 1% (n = 1) reported six needs,” Kaviany said.

Among the patients reporting more than one measure of deprivation, 49% identified housing assistance, 45% identified household triggers such as pests, mold and dust, 26% identified general assistance, 21% identified employment, 20% identified asthma at school, 18% identified public benefits and 17% identified food insecurity.

Requests for housing assistance included finding housing (61%), paying utilities (51%) and foreclosure counseling (8%).

“A striking outcome from this study is that almost half of the families surveyed identified at least one social need, most commonly linked with substandard living quarters,” Kaviany said.

These findings underscore how vital social determinants, including adequate housing and basic needs, shape inequalities associated with pediatric asthma health outcomes, she continued.

“These results emphasize the urgent need for interventions targeting both systemic social disadvantage and ecological hazards beyond purely medical strategies for tackling pediatric asthma,” Kaviany said.

Also, the ACT scores of the patients who reported household asthma triggers were an average of 2.3 points lower than the patients who did not (P = .02).

The patients who reported household triggers and who requested assistance with housing were concentrated in six neighborhood clusters in Southeast D.C.

“By using spatial mapping, we were able to see that the neighborhoods with the highest counts of social needs were in Ward 8 in Southeast D.C., where the rates of pediatric asthma morbidity and family poverty are also the highest,” Kaviany said.

“Specifically, in Ward 8, we identified two neighborhoods with the highest counts across all needs: Congress Heights/Bellevue/Washington Highlands and Douglas/Shipley Terrace,” she said.

In addition to most families reporting at least one measure of deprivation, the researchers said these findings indicate a correlation between the presence of household triggers and poorly controlled asthma.

Recommendations, next steps

By changing policy to elevate housing standards in Washington, D.C., the researchers continued, disparities in pediatric asthma may be mitigated.

“With these new results, health care providers can upgrade individualized care by incorporating social needs assessments into asthma management strategies,” Kaviany said.

Since needs for assistance with household asthma triggers were correlated with poorly controlled asthma, Kaviany said, screening for assistance with household asthma triggers may help identify high-risk patients.

Also, she continued, by investigating potential social determinants of health, including living conditions and economic stability during doctor-patient interactions, medical experts gain insight into the environment where patients reside, creating an ideal platform for devising customized approaches for managing symptoms effectively.

“For instance, when faced with complaints about household irritants like mold or pests worsening symptoms, physicians may direct patients towards resourceful organizations or implement measures to eliminate these trigger factors, resulting in improved management outcomes and reduced likelihood of future attacks,” she said.

Advocating for policies geared toward more comprehensive interventions aimed at eradicating social determinants of health gaps will alleviate pediatric asthma and rectify disparities experienced in such environments as well, she continued.

“Mandated rental housing inspections that identify mold, leaks and ventilation issues have potential to improve housing conditions significantly. More importantly, these mandates must be enforced on the local and federal level to be effective,” Kaviany said.

In particular, Kaviany said, the US Department of Housing and Urban Development needs to enforce these inspections for families that use the housing voucher program,

“Additionally, there is a need for federally funded legal aid for tenants to be able to advocate for their rights when landlords refuse to address the housing issues, as mandated by the law,” she said.

On the local level, Kaviany noted opportunities for doctors to work with the District of Columbia Public Schools Connected Schools program, which has three hubs in the high-risk neighborhoods identified by this study.

“The Connected Schools program serves as a community site for distribution of resources,” Kaviany said. “By taking this Social Needs Checklist to the community hub, we could identify high-risk families and provide resources to address housing concerns.”

Next, Kaviany said that she and her colleagues will use spatial mapping to characterize the community level factors such as toxic waste sites, traffic pollution, poverty and crime that may be contributing to worse housing conditions and higher counts of social needs in these specific neighborhoods.