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Mobility and social deprivation on primary care utilisation among paediatric patients with asthma
Jennifer A Lucas1, Miguel Marino2, Sophia Giebultowicz3
1Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA lucasje@ohsu.edu.
Insights
Children with asthma living in or moving to deprived neighborhoods use primary care more often. This suggests increased opportunities for intervention to improve asthma outcomes and health equity.
Area of Science:
- Public Health
- Health Services Research
- Pediatric Asthma Care
Background:
- Neighbourhood social and environmental factors significantly impact asthma care.
- Residential mobility is linked to adverse asthma outcomes, but its effect on primary care utilization in relation to neighbourhood deprivation is understudied.
Purpose of the Study:
- To examine the association between neighbourhood characteristics, residential mobility, and primary care utilization among children with asthma.
- To explore the relevance of social factors in primary care settings for managing pediatric asthma.
Main Methods:
- A cohort study utilizing data from 23,773 children with asthma (aged 3-17) across varying levels of neighbourhood social deprivation.
- Negative binomial regression was used to analyze rates of primary care visits and influenza vaccination, while logistic regression assessed pneumococcal vaccination receipt, with patient-level covariates adjusted.
Main Results:
- Children residing in or relocating to high-deprivation areas exhibited higher primary care visit rates compared to those in low-deprivation areas (RR 1.09 and 1.05).
- Children moving between high-deprivation neighbourhoods showed increased rates of influenza vaccination (RR 1.13) compared to those moving within low-deprivation areas.
Conclusions:
- Living in or moving to deprived neighbourhoods is associated with increased primary care utilization for children with asthma.
- These findings underscore the importance of considering patient mobility and implementing neighbourhood-targeted strategies to enhance equity and improve asthma care outcomes.
Objective:
Asthma 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.
Design:
In 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.
Setting:
We used data from community health centres in 15 OCHIN states.
Participants:
The 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.
Results:
Clinic 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.
Conclusions:
Movement 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.
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