Abstract
Objectives
Prior studies using single-center populations have established associations between
social risks and healthcare utilization among children with asthma. We aimed to evaluate
associations between social risks and healthcare utilization among a nationally representative
sample of children with asthma.
Study Design
In this cross-sectional study, we utilized the 2018-2019 National Survey of Children's
Health to identify children 2-17 years old with asthma. Using the Healthy People (HP)
2030 social determinants of health (SDOH) framework, we identified 31 survey items
assessing 18 caregiver-identified social risks as exposure variables and classified
them into the five HP SDOH domains (Economy, Education, Healthcare, Community, and
Environment). Primary outcome was caregiver-reported healthcare utilization. Associations
between individual social risks and total number of SDOH domains experienced with
healthcare utilization were assessed.
Results
The weighted study population included 8.05 million children, 96% of whom reported
≥1 social risk. Fourteen social risks, spanning all 5 SDOH domains, were significantly
associated with increased healthcare utilization. The 3 risks with the highest adjusted
odds ratios (aOR) of healthcare utilization included: experiencing discrimination
(aOR 3.26 [95% confidence interval (CI): 1.75, 6.08]); receiving free/reduced lunch
(aOR 2.16, [95% CI 1.57, 2.98]); and being a victim of violence (aOR 2.11, [95% CI
1.11, 4]). Children with risks across more SDOH domains reported significantly higher
health care utilization.
Conclusions
Among our national population of children with asthma, social risks are prevalent
and associated with increased healthcare utilization, highlighting their potential
contribution to pediatric asthma morbidity.
Key Words
Abbreviations:
NSCH (National Survey of Children's Health), HP (Healthy People), SDOH (social determinants of health), aOR (adjusted odds ratio), ED (emergency department), AAP (American Academy of Pediatrics)To read this article in full you will need to make a payment
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Article Info
Publication History
Accepted:
July 28,
2022
Received:
March 3,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc. on behalf of Academic Pediatric Association
