Abstract
Background and Objectives
Community level social determinants of health impact asthma outcomes among children,
however individual patient’s priorities are not often included in designing social
care interventions. Identifying connections between patient-prioritized unmet social
needs and asthma severity status may allow for improved patient-centered approaches
to asthma management. In this analysis, we examined the association between unmet
social needs and asthma severity in an urban population of children. We hypothesized
that those with a greater number of unmet social needs would report a more severe
asthma status.
Methods
We conducted a secondary analysis of 4,887 patients screened for unmet social needs
and asthma severity status. Bivariate associations and adjusted logistic regression
modeling were used to assess the association between unmet social needs and asthma
severity.
Results
Persistent asthma severity status was associated with several unmet social needs,
including housing quality and stability, lack of money for food, transportation, and
healthcare costs. In the multivariable analysis, having 3 or more unmet social needs
was associated with a 59% greater odds of persistent asthma status (CI 1.18-2.14;
P=0.002), and having two unmet social needs was associated with a 33% greater odds
of persistent asthma status (CI 1.00-1.78; P=0.05).
Conclusions
Unmet social needs were associated with asthma severity status, with a greater number
of unmet social needs associated with a greater odds of severe asthma status. Additional
studies are warranted to further evaluate the temporal relationship between unmet
social needs and how they may compound one another in their relationship with asthma
severity.
Keywords
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REFERENCES
- National Prevalence of Poor Asthma Control and Associated Outcomes Among School-Aged Children in the United States.J Allergy Clin Immunol Pract. 2018; 6 (Mar-Apr): 536-544https://doi.org/10.1016/j.jaip.2017.06.039
- Asthma Disparities in America: A Roadmap to Reducing Burden on Racial and Ethnic Minorities. 2020;
- Structural racism and its pathways to asthma and atopic dermatitis.Journal of Allergy and Clinical Immunology. 2021; 148: 1112-1120https://doi.org/10.1016/j.jaci.2021.09.020
- Measures of Racism, Sexism, Heterosexism, and Gender Binarism for Health Equity Research: From Structural Injustice to Embodied Harm-An Ecosocial Analysis.Annu Rev Public Health. 2020; 41 (Apr 2): 37-62https://doi.org/10.1146/annurev-publhealth-040119-094017
- Path to health asthma study: A survey of pediatric asthma in an urban community.J Asthma. 2017; 54 (Apr): 273-278https://doi.org/10.1080/02770903.2016.1216564
- Role of financial and social hardships in asthma racial disparities.Pediatrics. 2014; 133: 431-439https://doi.org/10.1542/peds.2013-2437
- Structural and Social Determinants of Health in Asthma in Developed Economies: a Scoping Review of Literature Published Between 2014 and 2019.Curr Allergy Asthma Rep. 2020; 20 (Feb 6): 5https://doi.org/10.1007/s11882-020-0899-6
- Situating household management of children’s asthma in the context of social, economic, and environmental injustice.Journal of Asthma. 2020; : 1-9https://doi.org/10.1080/02770903.2020.1837159
- Meanings and Misunderstandings: A Social Determinants of Health Lexicon for Health Care Systems.Milbank Q. 2019; 97 (Jun): 407-419https://doi.org/10.1111/1468-0009.12390
- Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health.Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. 2019;
- Clinical Approaches to Reducing Material Hardship Due to Poverty: Social Risks/Needs Identification and Interventions.Acad Pediatr. 2021; 21 (2021/11/01/): S154-S160https://doi.org/10.1016/j.acap.2021.02.007
- Poverty and Child Health in the United States.Pediatrics. 2016; 137 (Apr)https://doi.org/10.1542/peds.2016-0339
- Screening for Social Determinants of Health Among Children and Families Living in Poverty: A Guide for Clinicians.Curr Probl Pediatr Adolesc Health Care. 2016; 46 (May): 135-153https://doi.org/10.1016/j.cppeds.2016.02.004
- Effects of Social Needs Screening and In-Person Service Navigation on Child Health: A Randomized Clinical Trial.JAMA Pediatr. 2016; 170 (Nov 7)e162521https://doi.org/10.1001/jamapediatrics.2016.2521
- Social Risk Interventions and Health Care Utilization for Pediatric Asthma: A Systematic Review and Meta-analysis.JAMA Pediatrics. 2021; (e215103-e215103)https://doi.org/10.1001/jamapediatrics.2021.5103
National Heart, Lung, and Blood Institute,. National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. U.S. Department of Health and Human Services. Full Report 2007, NIH publication 08-4051. Accessed May 5, 2020 . 〈http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm〉
- Association of an Asthma Improvement Collaborative With Health Care Utilization in Medicaid-Insured Pediatric Patients in an Urban Community.JAMA Pediatr. 2017; 171 (Nov 1): 1072-1080https://doi.org/10.1001/jamapediatrics.2017.2600
- Screening Social Determinants of Health in a Multidisciplinary Severe Asthma Clinical Program.Pediatr Qual Saf. Sep-. 2020; 5 (Oct)e360https://doi.org/10.1097/pq9.0000000000000360
- Social Risks Among Primary Care Patients in a Large Urban Health System.Am J Prev Med. 2020; 58 (Apr): 514-525https://doi.org/10.1016/j.amepre.2019.11.011
- Toward Understanding Social Needs Among Primary Care Patients With Uncontrolled Diabetes.J Prim Care Community Health. Jan-. Dec 2021; (2150132720985044): 12https://doi.org/10.1177/2150132720985044
- The mediating roles of perceived stress and health behaviors in the relation between objective, subjective, and neighborhood socioeconomic status and perceived health.Annals of Behavioral Medicine. 2014; 48: 215-224
- Basic needs, stress and the effects of tailored health communication in vulnerable populations.Health Educ Res. 2015; 30 (Aug): 591-598https://doi.org/10.1093/her/cyv033
- Social determinants as moderators of the effectiveness of health behavior change interventions: scientific gaps and opportunities.Health Psychol Rev. 2020; 14 (Mar): 132-144https://doi.org/10.1080/17437199.2020.1718527
- Addressing Unmet Basic Resource Needs as Part of Chronic Cardiometabolic Disease Management.JAMA Intern Med. 2017; 177 (Feb 1): 244-252https://doi.org/10.1001/jamainternmed.2016.7691
- The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma.N Engl J Med. 1997; 336 (May 8): 1356-1363https://doi.org/10.1056/nejm199705083361904
- Housing code violation density associated with emergency department and hospital use by children with asthma.Health Aff (Millwood). 2014; 33 (Nov): 1993-2002https://doi.org/10.1377/hlthaff.2014.0496
- Housing and asthma disparities.Journal of Allergy and Clinical Immunology. 2021; 148 (2021/11/01/): 1121-1129https://doi.org/10.1016/j.jaci.2021.09.023
- The association between social needs and chronic conditions in a large, urban primary care population.Prev Med. 2021; 153 (Aug 1)106752https://doi.org/10.1016/j.ypmed.2021.106752
- Out-of-pocket medication costs and use of medications and health care services among children with asthma.JAMA. 2012; 307: 1284-1291https://doi.org/10.1001/jama.2012.340
- Paying to participate: financial, social and personal costs to parents of involvement in their children's care in hospital.Journal of Advanced Nursing. 1997; 25: 746-752https://doi.org/10.1046/j.1365-2648.1997.t01-1-1997025746.x
- Care more, earn less? The association between taking paid leave to care for sick children and wages among Swedish parents.Work, Employment and Society. 2019; 33: 983-1001
- Validation of asthma recording in electronic health records: a systematic review.Clin Epidemiol. 2017; 9: 643-656https://doi.org/10.2147/CLEP.S143718
- Defining asthma and assessing asthma outcomes using electronic health record data: a systematic scoping review.Eur Respir J. 2017; 49 (Jun)https://doi.org/10.1183/13993003.00204-2017
- Advancing the learning health system by incorporating social determinants.Am J Manag Care. 2020; 26 (Jan 1): e4-e6https://doi.org/10.37765/ajmc.2020.42146
Community Asthma Prevention Program (CAPP) + Home Repairs Program. Children's Hospital of Philadelphia. Accessed March 23, 2022 , 〈https://www.chop.edu/services/capp-home-repairs-program〉
Article info
Publication history
Accepted:
February 19,
2023
Received:
June 22,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc.
