Community Interventions for Childhood Asthma ED Visits and Hospitalizations: A Systematic Review

Systematic review to assess the effectiveness of community interventions to improve inequities in childhood asthma emergency department (ED) visits and hospitalizations.

Articles published from January 2010 to December 2021 that included children with asthma who underwent community interventions that were place-based (eg, zip codes, etc), community-led (eg, community health workers, etc) and/or sociodemographic-based (eg, race or income).

Search included 5 electronic databases and hand-searched references following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The main outcomes were childhood asthma ED visits and hospitalizations occurring after exposure to community interventions. Exclusion criteria included only nonclinical outcomes and interventions combined with drug therapies or exclusively examining school or clinical settings.

Twenty six heterogeneous articles primarily in Black and Hispanic populations (19 of 20 that reported race) in the United States and Puerto Rico (1 from Canada, 1 from Australia), divided into 4 categories: (1) care coordination (n = 8) through asthma education, connection and communication with health, social services, and schools that decreased ED visits by 36% to 63% and hospitalizations by 26% to78% (P = .01); (2) policy and environmental changes (n = 8) through regulation and enforcement of quality low-income housing standards and remediation, and policies reducing air pollutants such as tobacco smoke and industrial and traffic pollution, which had favorable but mixed effect on ED visits and hospitalizations; (3) home-based interventions (n = 6) in which health and environmental specialists identified and reduced exposure to cockroaches, dust mites, mold, and tobacco smoke which reduced ED visits and hospitalizations in half the studies (most notably by 53% and 68%, respectively in 1 study); and (4) community-based health services (n = 4) including a Breathmobile, cognitive behavioral therapy, and asthma educators in the home versus ED, which again found favorable, but mixed effects, on ED visits and hospitalizations. Significant bias in the majority of these studies was because of uncontrolled confounding factors and self-reported outcomes.

Community interventions focused on care coordination and policy and environmental changes have the greatest potential to positively impact ED visits and hospitalizations for low-income Black and Hispanic children with asthma in the United States.

In addition to interventions targeted at healthcare systems, schools, and individuals, community-based interventions help reduce health disparities caused by historical structural racism. Multifaceted activism is most likely to create more rapid and lasting health equity.