Geospatial Analysis of Social Determinants of Health Identifies Neighborhood Hot Spots Associated With Pediatric Intensive Care Use for Life-Threatening Asthma

Grunwell, Jocelyn R.; Opolka, Cydney; Mason, Carrie; Fitzpatrick, Anne M.

doi:10.1016/j.jaip.2021.10.065

Cited by 55 publications

(41 citation statements)

References 38 publications

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“…39,40 These interventions must be tailored to specific neighborhood-level risk factors and encourage a public health and systems approach to reducing inequities and fostering community health. 41 This exploratory pilot investigation is subject to several limitations. Control patients presenting to outpatient facilities may be more likely to have symptomatic COVID-19 triggering the testing, whereas many children developing MIS-C tend to have asymptomatic or mild primary infection.…”

Section: Discussionmentioning

confidence: 99%

Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-CoV-2 Infection

Zambrano

Link‐Gelles

et al. 2022

Pediatric Infectious Disease Journal

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Background: Multisystem inflammatory syndrome in children (MIS-C) is a postinfectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related complication that has disproportionately affected racial/ethnic minority children. We conducted a pilot study to investigate risk factors for MIS-C aiming to understand MIS-C disparities. Methods: This case-control study included MIS-C cases and SARS-CoV-2-positive outpatient controls less than 18 years old frequency-matched 4:1 to cases by age group and site. Patients hospitalized with MIS-C were admitted between March 16 and October 2, 2020, across 17 pediatric hospitals. We evaluated race, ethnicity, social vulnerability index (SVI), insurance status, weight-for-age and underlying medical conditions as risk factors using mixed effects multivariable logistic regression. Results: We compared 241 MIS-C cases with 817 outpatient SARS-CoV-2-positive at-risk controls. Cases and controls had similar sex, age and U.S. census region distribution. MIS-C patients were more frequently previously healthy, non-Hispanic Black, residing in higher SVI areas, and in the 95th percentile or higher for weight-for-age. In the multivariable analysis, the likelihood of MIS-C was higher among non-Hispanic Black children [adjusted odds ratio (aOR): 2.07; 95% CI: 1.23–3.48]. Additionally, SVI in the 2nd and 3rd tertiles (aOR: 1.88; 95% CI: 1.18–2.97 and aOR: 2.03; 95% CI: 1.19–3.47, respectively) were independent factors along with being previously healthy (aOR: 1.64; 95% CI: 1.18–2.28). Conclusions: In this study, non-Hispanic Black children were more likely to develop MIS-C after adjustment for sociodemographic factors, underlying medical conditions, and weight-for-age. Investigation of the potential contribution of immunologic, environmental, and other factors is warranted.

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Section: Discussionmentioning

confidence: 99%

Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-CoV-2 Infection

Zambrano

Link‐Gelles

et al. 2022

Pediatric Infectious Disease Journal

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“…Asthma prevalence increases as poverty levels decrease, and poverty independently has been associated with adverse asthma outcomes [19]. The geospatial ‘hotspots’ identified by Grunwell et al [33 ▪▪ ], also line up with the segregated neighborhoods created by historical ‘redlining’ [49,50]. These segregated neighborhoods have also been associated with decreased access to healthcare facilities and primary care providers, along with decreased educational opportunities [51,52].…”

Section: Systemic Racism and Asthma Riskmentioning

confidence: 97%

“…Recent application of geospatial models of social disadvantage to pediatric intensive care admissions and readmissions identified hotspots within Georgia where social vulnerability and low social opportunity were associated with life-threatening asthma exacerbations [33 ▪▪ ]. Increased crowding, lower access to greenspace, and slightly higher measures of particulate matter and pollutants in the air, water, and soil were among the hotspot characteristics.…”

Section: Outdoor Exposuresmentioning

confidence: 99%

Socioeconomic determinants of asthma health

Simoneau

Gaffin

2023

Current Opinion in Pediatrics

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Purpose of reviewThe current review provides an assessment of the recent pediatric literature evaluating socioeconomic drivers of asthma incidence and morbidity. The review addresses the specific social determinants of health related to housing, indoor and outdoor environmental exposures, healthcare access and quality, and the impact of systematic racism.Recent findingsMany social risk factors are associated with adverse asthma outcomes. Children living in low-income, urban neighborhoods have greater exposure to both indoor and outdoor hazards, including molds, mice, second-hand smoke, chemicals, and air pollutants, all of which are associated with adverse asthma outcomes. Providing asthma education in the community – via telehealth, school-based health centers, or peer mentors – are all effective methods for improving medication adherence and asthma outcomes. The racially segregated neighborhoods created by the racist ‘redlining’ policies implemented decades ago, persist today as hotspots of poverty, poor housing conditions, and adverse asthma outcomes.SummaryRoutine screening for social determinants of health in clinical settings is important to identify the social risk factors of pediatric patients with asthma. Interventions targeting social risk factors can improve pediatric asthma outcomes, but more studies are needed related to social risk interventions.

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“…The Robert Wood Johnson Foundation formed the Commission to Build a Healthier America, a nonpartisan group focused on improving public health outcomes for vulnerable populations, and released a report in 2014 comparing average life expectancy by county demonstrating wide variations in outcomes based on race/ethnicity, gender, income, and other factors [ 2 , 4 ]. A geospatial analysis showed that children with asthma residing in certain hotspot counties considered to be underserved have higher social vulnerabilities and are associated with longer hospital stay durations [ 5 ]. Another study found that social risk factors were associated with persistent functional disability caused by juvenile idiopathic arthritis [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

The Effects of COVID-19 Pandemic Policy on Social Needs Across the State of Kansas and Western Missouri: Paired Survey Response Testing

Mudaranthakam¹,

Pepper²,

Fortney³

et al. 2023

JMIR Public Health Surveill

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Background Studying patients’ social needs is critical to the understanding of health conditions and disparities, and to inform strategies for improving health outcomes. Studies have shown that people of color, low-income families, and those with lower educational attainment experience greater hardships related to social needs. The COVID-19 pandemic represents an event that severely impacted people’s social needs. This pandemic was declared by the World Health Organization on March 11, 2020, and contributed to food and housing insecurity, while highlighting weaknesses in the health care system surrounding access to care. To combat these issues, legislators implemented unique policies and procedures to help alleviate worsening social needs throughout the pandemic, which had not previously been exerted to this degree. We believe that improvements related to COVID-19 legislature and policy have positively impacted people’s social needs in Kansas and Missouri, United States. In particular, Wyandotte County is of interest as it suffers greatly from issues related to social needs that many of these COVID-19–related policies aimed to improve. Objective The research objective of this study was to evaluate the change in social needs before and after the COVID-19 pandemic declaration based on responses to a survey from The University of Kansas Health System (TUKHS). We further aimed to compare the social needs of respondents from Wyandotte County from those of respondents in other counties in the Kansas City metropolitan area. Methods Social needs survey data from 2016 to 2022 were collected from a 12-question patient-administered survey distributed by TUKHS during a patient visit. This provided a longitudinal data set with 248,582 observations, which was narrowed down into a paired-response data set for 50,441 individuals who had provided at least one response before and after March 11, 2020. These data were then bucketed by county into Cass (Missouri), Clay (Missouri), Jackson (Missouri), Johnson (Kansas), Leavenworth (Kansas), Platte (Missouri), Wyandotte (Kansas), and Other counties, creating groupings with at least 1000 responses in each category. A pre-post composite score was calculated for each individual by adding their coded responses (yes=1, no=0) across the 12 questions. The Stuart-Maxwell marginal homogeneity test was used to compare the pre and post composite scores across all counties. Additionally, McNemar tests were performed to compare responses before and after March 11, 2020, for each of the 12 questions across all counties. Finally, McNemar tests were performed for questions 1, 7, 8, 9, and 10 for each of the bucketed counties. Significance was assessed at P<.05 for all tests. Results The Stuart-Maxwell test for marginal homogeneity was significant (P<.001), indicating that respondents were overall less likely to identify an unmet social need after the COVID-19 pandemic. McNemar tests for individual questions indicated that after the COVID-19 pandemic, respondents across all counties were less likely to identify unmet social needs related to food availability (odds ratio [OR]=0.4073, P<.001), home utilities (OR=0.4538, P<.001), housing (OR=0.7143, P<.001), safety among cohabitants (OR=0.6148, P<.001), safety in their residential location (OR=0.6172, P<.001), child care (OR=0.7410, P<0.01), health care access (OR=0.3895, P<.001), medication adherence (OR=0.5449, P<.001), health care adherence (OR=0.6378, P<.001), and health care literacy (0.8729, P=.02), and were also less likely to request help with these unmet needs (OR=0.7368, P<.001) compared with prepandemic responses. Responses from individual counties were consistent with the overall results for the most part. Notably, no individual county demonstrated a significant reduction in social needs relating to a lack of companionship. Conclusions Post-COVID-19 responses showed improvement across almost all social needs–related questions, indicating that the federal policy response possibly had a positive impact on social needs across the populations of Kansas and western Missouri. Some counties were impacted more than others and positive outcomes were not limited to urban counties. The availability of resources, safety net services, access to health care, and educational opportunities could play a role in this change. Future research should focus on improving survey response rates from rural counties to increase their sample size, and to evaluate other explanatory variables such as food pantry access, educational status, employment opportunities, and access to community resources. Government policies should be an area of focused research as they may affect the social needs and health of the individuals considered in this analysis.

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Geospatial Analysis of Social Determinants of Health Identifies Neighborhood Hot Spots Associated With Pediatric Intensive Care Use for Life-Threatening Asthma

Cited by 55 publications

References 38 publications

Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-CoV-2 Infection

Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-CoV-2 Infection

Socioeconomic determinants of asthma health

The Effects of COVID-19 Pandemic Policy on Social Needs Across the State of Kansas and Western Missouri: Paired Survey Response Testing

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