Mobility and social deprivation on primary care utilisation among paediatric patients with asthma

Abstract

ObjectiveAsthma care is negatively impacted by neighbourhood social and environmental factors, and moving is associated with undesirable asthma outcomes. However, little is known about how movement into and living in areas of high deprivation relate to primary care use. We examined associations between neighbourhood characteristics, mobility and primary care utilisation of children with asthma to explore the relevance of these social factors in a primary care setting.DesignIn this cohort study, we conducted negative binomial regression to examine the rates of primary care visits and annual influenza vaccination and logistic regression to study receipt of pneumococcal vaccination. All models were adjusted for patient-level covariates.SettingWe used data from community health centres in 15 OCHIN states.ParticipantsThe sample included 23 773 children with asthma aged 3–17 across neighbourhoods with different levels of social deprivation from 2012 to 2017. We conducted negative binomial regression to examine the rates of primary care visits and annual influenza vaccination and logistic regression to study receipt of pneumococcal vaccination. All models were adjusted for patient-level covariates.ResultsClinic visit rates were higher among children living in or moving to areas with higher deprivation than those living in areas with low deprivation (rate ratio (RR) 1.09, 95% CI 1.02 to 1.17; RR 1.05, 95% CI 1.00 to 1.11). Children moving across neighbourhoods with similarly high levels of deprivation had increased RRs of influenza vaccination (RR 1.13, 95% CI 1.03 to 1.23) than those who moved but stayed in neighbourhoods of low deprivation.ConclusionsMovement into and living within areas of high deprivation is associated with more primary care use, and presumably greater opportunity to reduce undesirable asthma outcomes. These results highlight the need to attend to patient movement in primary care visits, and increase neighbourhood-targeted population management to improve equity and care for children with asthma.

Neighborhood-level social determinants of health measures independently predict receipt of living donor liver transplantation in the United States

“…Our analysis shows that LT recipients with an SDI score above a threshold score > 40 have a reduced likelihood of undergoing LDLT. In other areas of clinical medicine, studies have often described much higher relevant SDI thresholds, ranging from using the top 50% of SDI scores, [32] SDI ≥ 70, [33] to the highest 10% of SDI scores. [34] Our lower threshold for liver transplantation is likely explained by 2 factors: (1) a selection bias already exists among transplanted patients, such that they a priori have less socioeconomic deprivation than broader disease populations because of the rigorous demands on patients and families in the transplant evaluation process; and (2) achieving LDLT is inherently difficult for recipients and donors alike, such that even small differences in social risks can decrease access.…”

Disaggregating Latino nativity in equity research using electronic health records

“…Electronic health records (EHRs), an important source for health disparities research [22][23][24] in Latino populations, [25][26][27][28] likely contain significant populations of US and foreign-born Latinos, 29 and may report numerous demographics relevant to many Latinos (language, insurance, migrancy). 27,30,31 However, while EHRs have been used to conduct health disparities research in populations with a high prevalence of foreign-born Latinos, a lack of explicit country of birth data has been a persistent limitation of EHRs.…”

“…Until there is widespread implementation of this, a better estimation of the association of country of birth with health outcomes using routinely collected clinical data may help guide efforts in the future around which information needs to be collected and in what manner. Electronic health records (EHRs), an important source for health disparities research 22–24 in Latino populations, 25–28 likely contain significant populations of US and foreign‐born Latinos, 29 and may report numerous demographics relevant to many Latinos (language, insurance, migrancy) 27,30,31 . However, while EHRs have been used to conduct health disparities research in populations with a high prevalence of foreign‐born Latinos, a lack of explicit country of birth data has been a persistent limitation of EHRs.…”

Quality of Care for Latinx Children with Asthma: Associations with Language Concordance and Continuity of Care

“…3 Latinx have more asthma exacerbations than non-Hispanic White patients, and Latinx are twice as likely to visit the emergency department for asthma as compared with non-Hispanic Whites. [4][5][6] Asthma is a disease amenable to primary care intervention and management because much asthma care is administered in the primary care setting 7 , but there is still uncertainty concerning all the care factors that may influence this management.…”