Social risk interventions linked to fewer asthma ED visits, hospitalizations in children

Among children with asthma, social risk interventions were associated with decreased asthma-related ED visits and hospitalizations, researchers reported in JAMA Pediatrics.

“To date, existing asthma interventions had not been classified using the Healthy People social determinant of health framework,” Jordan Nichole Tyris, MD, hospital medicine fellow in the division of hospital medicine at Children’s National Hospital and the George Washington University School of Medicine and Health Sciences, Washington, D.C., told Healio. “In addition, their impact on asthma health care utilization from a social risk perspective had not been quantitatively synthesized.”

Tyris and colleagues searched PubMed, Scopus, PsycINFO, SocINDEX and CINAHL from January 2008 to June 2021 for U.S.-based studies that assessed the associations of interventions that addressed one or more social risks with asthma-related ED visits and hospitalizations in children. Of the 641 articles identified, the systematic review included 38 and the meta-analysis included 19, with a total of 5,441 participants.

Using the Healthy People 2020 social determinants of health framework, researchers identified intervention clusters using grouping studies based on the social risks addressed within. All social risk interventions included in these studies addressed one or more of the health (n = 35), environment (n = 21) and community (n = 15) domains.

Researchers observed an association between social risk interventions and decreased asthma-related ED visits (RR = 0.68; 95% CI, 0.57-0.81) and hospitalizations (RR = 0.5; 95% CI, 0.37-0.68) in the primary meta-analysis. In a subgroup analysis, the health, environment and community intervention cluster was associated with the lowest risk for asthma-related ED visits (RR = 0.53; 95% CI, 0.44-0.64) and hospitalizations (RR = 0.33; 95% CI, 0.2-0.55) compared with other social risk intervention clusters.

“Asthma interventions that address individual patients’ social risks — in particular, those that focus on improved health literacy, health care access, home environment remediation and peer support — were associated with reduced health care utilization among children with asthma in our review,” Tyris told Healio.

Looking ahead, “we know that addressing individual family’s social risks will not impact underlying population-level social determinants. Instead, population-level policies are required to change social determinants,” Tyris said. “We recommend prioritizing the evaluation of such policies and to specifically study their impact on health outcomes among children.”

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Jordan Nichole Tyris, MD, can be reached at jbarger@childrensnational.org.