P3B149: Race, Neighborhood Social Determinants and Acute Care Reutilization Rates for Children with Severe Asthma

Background: Children of minority race and those who reside in disadvantaged neighborhoods have higher rates of adverse asthma-related outcomes. We examined the relationship between neighborhood resources, race, and acute care utilization for children with severe asthma during the first year of discharge from a single-center pediatric intensive care unit (PICU).

Methods: We performed a retrospective study of 458 children (2-18 years) admitted to the PICU with severe asthma exacerbation over six years. We collected clinical and demographic data. Race was examined as a social construct and categorized into White, Black, and 'Other'. Patients’ residential addresses were geocoded and used to assess the child opportunity index (COI) at the census tract level (COI-a composite measure of neighborhood-level factors that impact child health; categorized into five quintiles -Very High (VH-COI) to Very Low (VL-COI)). We also calculated the density of pediatric primary care providers (PCP) within each COI quintile. Study outcomes were rate of acute care utilization (hospital/PICU readmission and emergency department (ED) visit at 30, 90,180, and 365 days after PICU discharge). We analyzed the relationship between race, COI, and study outcomes using multivariable Poisson regression adjusted for demographic and clinical factors.

Results: Median age was 6.7 years (IQR: 4.5-10.3). Majority were publicly insured (75%), urban residents (84%) Black (47.8%), and 44% resided in VL-COI areas while only 5.9% resided in VH-COI. Significant differences in COI distribution by race were present- Black (52%) and 'Other' (55%) race resided in VL-COI areas. For all forms of acute care, Black patients that the highest percent of utilization at all time intervals (Table). Compared to White patients, Black patients had higher rates of ICU readmission at 180-days (6.53 (95% CI 1.89-41.1) and 365-days (2.59 (95% CI 1.18-6.50) and also had higher rates of ED visits at 180-days (IRR 1.85 (95% CI 1.15-3.09) and at 365-days (IRR 1.84 (95% CI 1.31-2.62). There was no significant association between COI and ICU or hospital readmission. Compared with VH-COI areas, the rate of ED visits was higher at 180-days and 365-days for those who resided in L-COI and VL-COI areas. VL and L-COI areas had 3.2 and 69 pediatric PCP per 10,000 children (aged 0-17 years) respectively.

Conclusion: Our findings suggest that for children with severe asthma, racial and neighborhood disparities in rates of acute care use after PICU discharge arise beyond the immediate discharge period. Promoting equity in long-term outcomes of pediatric asthma may require a greater focus on the upstream social and structural factors that potentiate these disparities within the community such as resource availability and access to primary care.