Many of us counsel families of our patients with asthma on environmental risks that can make the asthma more difficult to control.
Geospatial analysis, which uses geographic data (such as census tracts, zip codes, or street addresses) to identify trends or patterns, has made it clear that neighborhood-level factors also impact asthma morbidity for the children who live in these communities. Children living in communities with high levels of poverty and crime are more likely to have higher rates of emergency department (ED) visits and hospitalizations for asthma.
This week, Pediatrics is early releasing an article and an accompanying video abstract, entitled, “Social Determinants of Health and At-Risk Rates for Pediatric Asthma Morbidity,” by Dr. Jordan Tyris and colleagues at Children’s National Hospital and George Washington University that takes geospatial analysis to the next level (10.1542/peds.2021-055570).
The authors build upon data looking at population-based rates at the census-tract level and calculate at-risk rates (ARRs), which divide asthma-related encounters only by children with asthma in a specific geographic area. By looking only at children at risk for asthma, ARRs may be more accurate in assessing the contribution of social determinants of health (SDOH) to disparities in asthma morbidity.
The authors used several databases to look at census tracts in Washington, DC. Specifically, they looked at
- Pediatric asthma morbidity, defined as asthma-related ED visits, hospitalizations, and critical care hospitalizations
- SDOH variables: rates of high school graduation, English proficiency, violent crime, vacant non-vacation homes, poverty
You can read the details of the analysis in the paper. Ultimately, the authors found that decreased educational attainment was associated with ARRs for hospitalizations and ED visits, and that violent crime was associated with ARRs for ED visits.
What do we do with this information? Dr. Lara Akinbami from the National Center for Health Statistics and Dr. Tara Bryant-Stephens, from Children’s Hospital of Philadelphia, in an invited commentary, point out that these problems are long-standing and require systems-based and community-centered approaches (10.1542/peds.2022-057206). We cannot work in silos to fix these issues; we need to work together within each of these communities.