O2064: Influence of Social and Environmental Determinants of Health on Respiratory Outcomes in Pediatric Asthma

Background: Pediatric asthma is the most common chronic disease of childhood, and results in billions of dollars in hospital charges, regular loss of school and work days, and increased total number of years lived with disability. Pediatric asthma is heavily influenced by social and environmental determinants of health, with Black race associated with higher rates of childhood asthma, and poverty associated with worse asthma outcomes. Pediatric asthma symptoms and lung function are worse, and exacerbations and hospitalizations are more frequent, in areas with high levels of air pollution. Few studies have investigated the influence of specific social and environmental determinants of health on pediatric asthma using large-scale geocoding data combined with clinical electronic health record (EHR) data. This study aimed to quantify the impact of social and environmental determinants of health on disease severity among children presenting to the hospital for asthma.

Methods: The study performed was a longitudinal observational study. The study population included all subjects from 2–18 years of age who presented to the hospital with an international classification of diseases (ICD) code for asthma from January 2010–December 2019. Study data were obtained from the Indiana Network for Patient Care (INPC), a comprehensive state-wide health information exchange that incorporates data from more than 90% of the hospitals in Indiana and over 17 million unique subjects. The primary outcome was highest level of respiratory support used during the hospital encounter, with high flow nasal cannula (HFNC), noninvasive positive pressure ventilation (NIPPV), and intubation with mechanical ventilation as the measured categories in increasing order. Logistic regression models including social determinants of health, environmental determinants of health, and vital signs at presentation were used to identify odds ratios (OR) associated with receiving each respiratory modality. Subgroups were created separating the population into three age groups.

Results: Several social and environmental determinants of health were significantly associated with the degree of respiratory support used. Social and environmental factors associated with maximum support of intubation and mechanical ventilation included aggregate particulate matter: OR 1.73 (1.59-1.89, p< 0.01); urban environment: OR 0.79 (0.64-0.97, p=0.03); Black race: OR 0.68 (0.56-0.82, p< 0.01); and Hispanic ethnicity: OR 0.51 (0.36-0.73, p< 0.01). Social and environmental factors associated with maximum support of NIPPV were social vulnerability index: OR 0.63 (0.49-0.81, p< 0.01); and poverty rate: OR 0.52 (0.29-0.92, p< 0.02). The only social or environmental factor associated with maximum support of HFNC was aggregate particulate matter: OR 0.79 (0.73-0.85, p< 0.01)

Conclusion: Aggregate particulate matter is significantly associated with intubation and mechanical ventilation for children presenting to the hospital for asthma. This will help clinicians identify patients with an increased likelihood of poor outcomes based on their determinants of health and inform efforts intended to reduce the burden of pediatric asthma.