Social Determinants of Health Influence Preschool and Caregiver Experiences During Symptoms and Exacerbations of Wheezing

To explore how social determinants of health, specifically social vulnerability, influence preschool children’s symptoms and exacerbation experiences with recurrent wheezing and their caregivers.

The study population included preschool children aged 12 to 59 months and their caregivers. Children with recurrent wheezing, defined as a lifetime history of 2 or more episodes of wheezing lasting at least 24 hours each, and at least 1 wheezing episode requiring treatment with systemic corticosteroids.

Enrollment for this 12-month longitudinal study was completed between September 2019 and September 2022. During enrollment, caregivers completed demographic questionnaires and medical history questionnaires, and kids were assessed for various allergen sensitization using IgE values. Participant residential census tract was geocoded, joining patient data to the Child Opportunity Index. Caregivers were given a diary to document a worsening of respiratory symptoms in their children at home using an adapted Pediatric Asthma Caregiver Diary and the Pediatric Asthma Caregiver’s Quality of Life Questionnaire. Social vulnerability was determined using self-reported race, ethnicity, household education, and income, then a composite score categorized participants into 3 groups: low, intermediate, and high-risk. At follow-up visits (weeks 14, 26, 38, 50), outcome measures consisted of child respiratory symptom scores, Test for Respiratory and Asthma Control in Kids questionnaire scores, caregiver-reported mental and social health outcomes, exacerbations, and health care utilization.

The study enrolled 79 preschool children and their caregivers. Children in the high-risk social vulnerability group exhibited greater daily symptom severity and more severe symptoms during acute exacerbations. Children in the low-risk group were more likely to receive unscheduled outpatient care (2.0 ± 1.5 vs 0.70 ± 0.91 vs 0.69 ± 1.0 visits for low versus intermediate versus high risk, P = .04). High-risk children had significantly higher symptom scores on the day of prednisolone administration and received significantly more albuterol. High-risk caregivers reported lower quality of life at the onset of exacerbation, which correlated with symptom severity scores, even after symptom resolution.

In preschool children with recurrent wheezing, social determinants of health specific to social vulnerability were linked to a higher symptom burden and reduced general life satisfaction and quality of life in their caregivers.

This study focuses on the profound impact of social determinants on the health experiences of preschool children with wheezing and their caregivers. This study suggests that among children at high risk and families, interventions aimed at improving health outcomes for children with wheezing should consider broader social and economic factors. In addition, this highlights the importance of healthcare provider awareness of important social and economic factors when considering and implementing treatment plans. Although further research is needed to fully understand the specific factors that contribute to symptom management and healthcare utilization, it is evident that addressing these determinants, such as improved access to healthcare services, education programs for caregivers, and community support initiatives, is necessary. Utilization of integrated health and social care policies using a more holistic healthcare approach that includes social support shows promise in addressing these disparities and leading to better management of wheezing in preschool children.