The influence of social and environmental determinants of health on hospitalizations for pediatric asthma

Abstract

Background

Asthma is the most common chronic disease of childhood, and has several social, environmental, and demographic factors potentially influential to its disease burden. This study sought to determine the influence of these factors on hospital admissions and readmissions for pediatric asthma.

Methods

This was a retrospective cohort study using data from the Indiana Network for Patient Care, a state-wide health information exchange in the United States. Study participants were children 2-18 years old admitted to the hospital with a respiratory diagnostic code between 2010 and 2021. Clinical variables were obtained from electronic health record data, and social and environmental determinants of health data were obtained from the Indiana Social Assets and Vulnerabilities Indicators using geocoding systems. Negative binomial models were used to examine community level social and environmental risk factors modifying the relationship between patient characteristics and the risk of asthma-related hospitalizations and 30-day readmissions.

Results

The study sample included 25,063 patients with an average follow-up of 9 (SD = 5) years. Of these, there were 17,816 asthma-related admissions. There were a total of 1,037 asthma-related 30-day readmissions, with an incidence rate of readmissions relative to total visits of 0.028 per person-year. A high social vulnerability index (SVI) was associated with an increased rate of hospital admissions (Proportion attributable ratio: 1.09, 95%CI (1.03,1.15), p < 0.05). No environmental determinants of health were significantly associated with hospitalization rate.

Conclusion

High SVI was significantly associated with increased risk of total hospital admissions for pediatric asthma.

Keywords:

• Informatics
• equity
• social vulnerability
• environmental exposure
• disparity

Authors’ contributions

Dr. Colin Rogerson: Contributed to study idea, design, data formatting and analysis, manuscript drafting, and revising and editing. Dr. Arthur Owora: Contributed to study idea, design, data formatting and analysis, manuscript drafting, and revising and editing. Dr. Wanzhu Tu: Contributed to study design, and revising and editing the manuscript. Dr. Eneida Mendonca: Contributed to study design, and revising and editing the manuscript.

Disclosure statement

The authors have disclosed that they do not have any potential conflicts of interest.

Additional information

Funding

This study was supported by the Internal Health Equity and Disparity Research Grant from the Regenstrief Institute.