Social vulnerability worsens outcomes in wheezing preschool children
Published: February 1, 2022
Recurrent wheezing in preschool children is increasing in prevalence in the United States and is a significant driver of respiratory-related costs in children. Each year, nearly half of all preschool children with recurrent wheezing have a significant exacerbation necessitating medical care. Although it is increasingly recognized that social determinants of health are important drivers of respiratory morbidity in children, social determinants of health have been largely understudied in preschool children with recurrent wheezing.
In this issue of The Journal of Allergy and Clinical Immunology: In Practice, Mutic and colleagues compared baseline and longitudinal outcomes in a large, multi-center population of well-characterized and adherent preschool children age 12-71 months (N=821) receiving standardized and supervised care for wheezing. Children were stratified by a composite measure of social vulnerability based on individual-level variables. Primary outcomes included days with upper respiratory infections and days with asthma symptom flares. Other outcomes included symptom scores during upper respiratory infections and respiratory symptom flare days, exacerbation occurrence, quality of life during the exacerbation and hospitalization.
Preschool children at highest risk of social vulnerability (N=165) did not have more frequent upper respiratory infections, respiratory symptoms, or exacerbations. Instead, children at highest risk of social vulnerability had more severe symptoms during upper respiratory infections and respiratory flare days, as well as more severe exacerbations with significantly poorer caregiver quality of life. Children at highest risk of social vulnerability also lived in poorer housing conditions with differing exposures and self-reported triggers. These results suggest that individual-level social determinants of health reflecting social vulnerability are associated with poorer outcomes in preschool children with recurrent wheezing despite access to supervised and standardized care. Comprehensive assessment of social determinants of health is warranted in even the youngest children with wheezing, since mitigation of these social inequities is an essential first step toward improving outcomes in pediatric patients.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.