All hospitalists have come across cases of children with asthma impacted by their environment, from the child in the moldy home to the child without transport to their PCP. As they come through our hospital doors, we are often able to fix their asthma exacerbation but frequently are unable to address the disparities in social determinants of health that cause their frequent returns.
Most of the research exploring these social determinants of health has focused on single factors both at the individual and population level. The Childhood Opportunity Index (COI) allows for a multidimensional view of how neighborhood-level elements can impact a child’s health. The authors of the Hospital Pediatrics article “Childhood Opportunity Index and Outcomes Across the Care Continuum for Children With Asthma” aimed to determine if COI is associated with different outcomes in pediatric hospitalization of children with asthma (10.1542/hpeds.2024-007976).
The authors conducted a multicenter and retrospective cohort study from May 2021 to May 2022 using the PHIS database. They identified over 19,000 children who were followed from pre-hospitalization to a year from discharge to identify asthma hospitalization outcomes. They found that children with lower COI were more likely to have severe illness requiring ICU admission. They were also more likely to be re-admitted for asthma within 30 days. Lastly, children with lower COI made up the majority of pediatric asthma hospitalizations. Their overall conclusions point to a connection between a child’s neighborhood environment and their vulnerability to negative asthma outcomes.
This study helps explore a new classification of various social determinants of health at the neighborhood level. This further supports but also narrows down the scope of literature exploring the factors leading to poor health outcomes in pediatric asthma. The findings of this study reinforce the importance of advocating for social change by addressing community-level social determinants of health. As hospitalists, we may have more time and resources to address these social factors including health literacy, medical-legal partnerships, and helping meet families’ social needs. Although we have achieved great standard of care in the treatment of asthma exacerbation, we can start screening and addressing social determinants of health in order to better address the root causes of these asthma flares.
