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The Child Opportunity Index and asthma morbidity among children younger than 5 years old in Washington, DC
Jordan Tyris1, Anand Gourishankar1, Nikita Kachroo2
1Children's National Hospital, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington.
Insights
Improving community opportunity, specifically social, economic, and educational factors, may reduce emergency asthma visits for young children. This study examined the Child Opportunity Index and pediatric asthma emergency department visits in Washington, DC.
Area of Science:
- Environmental Health
- Pediatric Asthma Research
- Social Determinants of Health
Background:
- Place-based social determinants of health significantly impact pediatric asthma morbidity.
- Limited evidence exists on the correlation between social determinants of health and asthma in children under five years old.
Purpose of the Study:
- To evaluate the association between the Child Opportunity Index (COI) and at-risk rates (ARRs) for pediatric asthma-related emergency department (ED) encounters and hospitalizations in Washington, DC.
Main Methods:
- Cross-sectional study of children under five with asthma in the DC Asthma Registry (January 2018-December 2019).
- Census tract COI scores and their domains (social/economic, health/environmental, educational) were analyzed as exposures.
- ED and hospitalization ARRs were calculated and adjusted for demographic, clinical, and community covariates.
Main Results:
- Higher overall COI, social/economic COI, and educational COI were linked to fewer ED ARRs.
- No significant associations were found between health/environmental COI and ED ARRs.
- No associations were observed between the COI and asthma-related hospitalizations.
Conclusions:
- Enhancing community-level social, economic, and educational opportunities in census tracts may decrease asthma-related ED visits for children under five.
- Targeted interventions addressing opportunity disparities could mitigate pediatric asthma morbidity.
Background:
Place-based social determinants of health are associated with pediatric asthma morbidity. However, there is little evidence on how social determinants of health correlate to the disproportionately high rates of asthma morbidity experienced by children <5 years old.
Objectives:
This study sought to evaluate census tract associations between the Child Opportunity Index ±COI) and at-risk rates (ARRs) for pediatric asthma-related emergency department (ED) encounters and hospitalizations in Washington, DC.
Methods:
This was a cross-sectional study of children <5 years old with physician-diagnosed asthma included in the DC Asthma Registry between January 2018 and December 2019. Census tract COI score (1-100) and its 3 domains (social/economic, health/environmental, and educational) were the exposures (source: www.diversitydatakids.org). ED and hospitalization ARRs (outcomes) were created by dividing counts of ED encounters and hospitalizations by populations with asthma for each census tract and adjusted for population-level demographic (age, sex, insurance), clinical (asthma severity), and community (violent crime and limited English proficiency) covariates.
Results:
Within a study population of 3806 children with a mean age of 2.4 ± 1.4 years, 2132 (56%) had 5852 ED encounters, and 821 (22%) had 1418 hospitalizations. Greater census tract overall COI, social/economic COI, and educational COI were associated with fewer ED ARRs. There were no associations between the health/environmental COI and ED ARRs or between the COI and hospitalization ARRs.
Conclusion:
Improving community-level social, economic, and educational opportunity within specific census tracts may reduce ED ARRs in this population.
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