Asthma is one of the most common causes of pediatric hospitalizations, despite our best efforts in proactive management. One high-risk group that you might not think about is children who are homeless. This is described in a study by Sakai-Bizmark et al. (10.1542/peds.2018-2769) being early released this week in our journal. The authors did a secondary analysis of data gathered in the state of New York regarding the prevalence of asthma in pediatric patients under 18 years of age between 2009-2014. The authors looked over that time period at almost 72,000 hospitalizations and whether being homeless increased the rate of hospitalization, readmissions, admissions through the emergency department, and need for a ventilator in severe cases. The findings are quite dramatic and supportive of the authors’ hypothesis in that there were 73.75 hospitalizations per 1000 homeless children compared to only 2.34 hospitalizations per 1000 non-homeless children. Even if non-homeless children in the lower income bracket studied had increased rates of asthma, homeless children had even higher rates. The other parameters studied regarding hospitalizations also showed significant differences with the homeless children of New York far-exceeding non-homeless in terms of needing inpatient care.
So what can or should we be doing about this stark contrast relative to our own patients, some of whom may also be homeless? We asked Drs. Kerry Sease and Jane Amati from the University of South Carolina (10.1542/peds.2019-0500) to share their thoughts on this study in an accompanying commentary. They comment on what might be the causes for this high rate of hospitalization in children who are homeless, including the toxic environmental conditions they live in, the number of infections they experience, or even the role of toxic stress from adverse social determinants of health, and reiterate the importance of finding adequate housing for all children and families. Screening for housing concerns is probably just as important as screening for food insecurity, and this study and commentary will convince you of that, if you are not doing this screening already.
