Neighborhoods best predict exacerbations among urban children with asthma

Key takeaways:

• Odds for exacerbation-prone classification increased 40% with each 20-point decrease in Child Opportunity Index 2.0 scores.
• Exacerbation-prone odds increased 10% with each $5,000 decrease in household income.

WASHINGTON — Childhood Opportunity Index 2.0 scores better predicted whether children with asthma in urban areas will experience exacerbations compared with household income or parental education, according to published data.

“Research has shown that social determinants of health underlie significant health disparities among children with asthma,” Emily Skeen, MD, pediatric pulmonary fellow at University of Colorado at Children’s Hospital Colorado and corresponding author of the study, which was presented at the American Thoracic Society International Conference, said in a press release.

“We know that these factors do not act in isolation, so we used a composite score of neighborhood-level child opportunity to determine whether it would predict exacerbation-prone asthma better than individual socioeconomic indicators,” Skeen continued.

Normalized on a scale of 0 to 100 with higher scores representing greater opportunity, the Child Opportunity Index 2.0 (COI) assesses 29 indices across education, health/environment and social/economic domains.

“We chose to use the COI in our study as it is the only composite measure of neighborhood conditions that is specific to children,” Skeen said.

The researchers calculated COI scores for 193 children aged 8 to 17 years (median age, 11.8 years; 62% boys; 21% Black; 58% Hispanic) with asthma participating in an observational study at a tertiary-care hospital in the Denver area. Also, the researchers collected data about their annual household income and their parents’ educational attainment.

According to the researchers, 74% of the cohort was prone to exacerbations, defined as experiencing one or more exacerbations within the previous year.

Patients who were prone to exacerbations were younger than those who were not (median ages, 11.6 vs. 12.6 years). They also were more predominantly boys (65% vs. 55%) and Hispanic (65% vs. 39%).

The cohort drew patients from 143 unique urban neighborhoods with an overall COI of 43 (range, 21-74). Median household income was in the $25,000 to $29,999 range. Of the 28% of parents who completed high school, 49% completed any college.

With each 20-point decrease in overall COI, the researchers said, the odds for exacerbation-prone classification increased by 40% (P = .004).

Similarly, odds increased by 38% in the education domain (P = .003) and by 37% in the social/economic domain (P = .011) with each 20-point decrease in COI.

The researchers also found that exacerbation-prone odds increased 10% with each $5,000 decrease in household income (P = .037) but there was no significant association between parental education and outcomes.

Multivariate models that included age and sex predictors (OR = 1.38; P = .007), Hispanic ethnicity (OR = 1.27; P = .05) and age, sex and ethnicity (OR = 1.27) showed similar impacts for COI on exacerbation-prone status, the researchers said.

Based on these results, the researchers called COI a stronger predictor of exacerbation-prone asthma status than household income and parental education. Also, they continued, these findings highlight how COI may be used to identify children at risk for undertreated or more severe asthma.

“Our finding that lower neighborhood-level opportunity is associated with increased risk of exacerbation-prone asthma suggests that the significant burden caused by frequent asthma exacerbations could be mediated with targeted community interventions rather than focusing on individual-level interventions alone,” Skeen said.

Reference:

• For urban children with asthma, where they live is strongest predictor of exacerbations. https://www.thoracic.org/about/newsroom/press-releases/conference/resources/asthma-exacerbation-in-urban-kids.pdf. Published May 22, 2023. Accessed May 22, 2023.