Pediatric patients living in socially vulnerable areas see more asthma hospital admissions
Key takeaways:
- In PICU and ward admissions, researchers found similar social vulnerability values.
- The social vulnerability value of those with multiple admissions significantly differed from those with a single admission.
The likelihood for multiple asthma hospital admissions was greater among youth living in more socially vulnerable areas, as well as areas with less opportunity, according to results published in Pediatric Allergy and Immunology.
“Although [Social Vulnerability Index (SVI)] and [Childhood Opportunity Index (COI)] were not overall associated with PICU vs. ward admission for status asthmaticus, our study demonstrated that higher SVI and lower COI are associated with multiple hospital admissions for status asthmaticus,” Justin Jones, MD, pediatric critical care fellow at Children’s Hospital Los Angeles, and colleagues wrote.
In this study, Jones and colleagues assessed 2,458 PICU and pediatric ward admissions for status asthma (n = 1,983) between January 2017 and March 2022 to establish the link between the odds for admission and two social vulnerability scores, as well as if these scores differ by admission location and number of admissions.
Researchers evaluated the social vulnerability of a patient’s residence through the CDC SVI, which includes 16 variables from the U.S. census to determine if an area “may need support before, during or after disasters,” according to a CDC webpage. SVI scores of 0 represent the least vulnerable communities and scores of 1 represent the most vulnerable.
Patients’ COI 2.0 score was also calculated, which encompasses 29 individual social determinants of health to describe how well an area encourages healthy childhood development in three domains: educational, health/environmental and social/economic. Higher scores on this scale of 0 to 100 signify increased opportunity.
Within the total cohort, researchers observed a median SVI of 0.86 and a median COI of 25.
“The median SVI score of 0.86 indicates a population that is more socially vulnerable than all but 14% of the U.S. population,” Jones and colleagues wrote. “Similarly, the median COI value of our patients demonstrates a population among those with the lowest childhood opportunity nationwide.”
Odds for pediatric ICU admission
There were 1,645 patients (median age, 4.7 years; 13.4% Black; 60.5% Hispanic) admitted to the pediatric ward, leaving 338 patients (median age, 6.2 years; 23.4% Black; 46.7% Hispanic) admitted to the PICU.
In both admission locations, researchers found similar median SVI values during univariate analysis. This was also true for the median COIs of pediatric wards and PICUs.
Researchers reported comparable, nonsignificant odds for PICU admission when SVI quintile 1 was placed against quintiles 2, 3, 4 and 5 individually via a race- and age-adjusted multivariable logistic regression model.
The only comparison in the COI model that yielded significant odds for PICU admission was COI quintile 2 vs. quintile 5, the reference quintile (OR = 0.61; 95% CI, 0.41-0.92), according to the study.
Odds for multiple hospital admissions
Most patients had only one admission (n = 1,661; median age, 5 years; 14.77% Black; 23.75% Latino), with multiple admissions occurring in fewer patients (n = 322; median age, 4.1 years; 16.77% Black; 35.4% Latino).
Researchers found that the median SVI value of those with multiple admissions significantly differed from the value of those with a single admission (0.88 vs. 0.86; P = .001). This outcome was also observed for the median COIs (multiple admission group, 19 vs. single admission group, 27; P < .001).
Notably, the study reported significant links between the likelihood for multiple asthma hospital admissions and three SVI quintiles on the higher side of the scale: SVI quintile 3 vs. quintile 1 (OR = 1.57; 95% CI, 1.04-2.37), quintile 4 vs. quintile 1 (OR = 1.54; 95% CI, 1.02-2.33) and quintile 5 vs. quintile 1 (OR = 1.63; 95% CI, 1.08-2.46).
For COI, researchers found a significant link between the likelihood for multiple asthma hospital admissions and the lowest COI quintile, quintile 1 (vs. quintile 5; OR = 1.85; 95% CI, 1.25-2.75).
“Future research in this area is needed,” Jones and colleagues wrote. “Possibilities include repeating the study collectively with a number of centers in a large metropolitan area to increase the distribution of social vulnerability and to include specific patient-level factors such as allergens or air pollution.”
Reference:
- Social Vulnerability Index. https://www.atsdr.cdc.gov/place-health/php/svi/index.html. Published July 22, 2024. Accessed Jan. 23, 2025.
Perspective
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My initial reaction to these results is that admission to PICU for asthma is generally done through very specific protocols, and this is reflected by the lack of significant differences seen in those admitted to the inpatient hospital wards vs. the PICU. However, I am not sure that is the only factor since the entire Children’s Hospital Los Angeles population was skewed to have a low COI and high SVI, meaning that their entire population would be considered under-resourced, making differences between PICU and wards difficult to be found.
That being said, regardless of the SVI or COI, Black children were more likely to be admitted to the PICU for asthma overall, and those children with multiple admissions to the PICU did show a skewing toward more social “disadvantage.” These findings, given the context, are not surprising. I have found that children with multiple admissions to the PICU require screening and social economic resource referrals to address the social determinants of health that they experience. It may be helpful to address some of these needs inpatient, perhaps prioritizing those with multiple PICU admissions to not only ensure asthma subspecialist follow-up, but a complete social determinants of health screen and referral to services to support the families’ socioeconomic needs.
The next step in this research and clinical care is to find a real-time way to act on these data when someone is admitted, ensuring the child and their family receives the support they need.
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