Mapping neighborhood hot spots in life-threatening childhood asthma
Published: November 10, 2021
Social determinants of health are associated with asthma prevalence and hospitalization in children but are multifactorial and complex. Social determinants of pediatric intensive care unit admission and readmission for asthma are not well-described.
In this issue of The Journal of Allergy and Clinical Immunology: In Practice, Grunwell and colleagues examined the social vulnerability and childhood opportunity indices of neighborhood hot spots by geocoding residential addresses of children, age 6 – 17 years, who were admitted to two Atlanta, GA pediatric intensive care units for life-threatening asthma attacks between 2015 – 2020. Neighborhood hot spots were defined as census tracts where pediatric intensive care admission rates for asthma per 1,000 children were at or above the 90th percentile. The primary exposure was living in a hot spot neighborhood (n = 228/1,403, 16%). The primary outcome measure was readmission to a pediatric intensive care unit for an asthma attack. Secondary outcomes included inpatient bed days defined as the sum of total days in the hospital for children living in a census tract and inpatient bed days rate where the inpatient bed days was normalized per 1,000 children living in the census tract. The social vulnerability and childhood opportunity indices were evaluated for children with multiple intensive care admissions for asthma.
Neighborhood hot spots with high (i.e., poorer) social vulnerability and low (i.e., poorer) childhood opportunity, reflecting differences in social and economic domains, household composition and disability, and housing type and transportation, education, health and environment, and were identified using geospatial analysis. Neighborhood hot spots were associated with longer hospital stays in school-age children. Children with multiple intensive care admissions lived in neighborhoods with poorer social vulnerability and childhood opportunity indices. These results suggest that comprehensive assessment and mitigation of social determinants of health, in addition to biological factors, may improve health equity and the need for intensive care admission in children with life-threatening asthma attacks.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.