Association of Social Drivers of Health With Hospitalizations for Pediatric Asthma

Social drivers of health (SDOH) impact health outcomes for children with asthma. Advances in geocoding enable better SDOH measurement in research. We aimed to: 1) examine relationship between three SDOH composite indices-Social Vulnerability Index (SVI), Childhood Opportunity Index 3.0 (COI), Area Deprivation Index (ADI)-and asthma patient disposition from emergency room; and 2) determine which index most closely correlates with admission rates.

Retrospective cohort study, patients 2-18 years presenting for asthma, defined using computational phenotype requiring: asthma diagnostic code, ≥2 doses nebulized albuterol, and ≥1 systemic steroid dose within 24 h of presentation. Data obtained 2021-2024 from Indiana Network for Patient Care, a state-wide health information exchange. Exposures included three SDOH indices. Mixed effects multinomial logistic regression to evaluate associations with patient disposition and recurrent emergency room encounters.

Total 5895 asthma encounters (4485 patients), with 27.85% resulting in admission (57.3% ward, 42.6 ICU). Female gender, chronic illness, "other" preferred language, >1 year since last outpatient visit increased admission likelihood. Black race and preferred language Spanish were associated with lower likelihood (vs. white, English-speaking reference). No SDOH indicator provided superior differentiation of patient disposition. However, census tract-level random effects were meaningful across all three models.

Gender, race, language, chronic comorbidity, and preventive healthcare access are associated with emergency and repeat hospital use in pediatric asthma. Geographic context plays a meaningful role in patients' clinical disposition, but the geographic component driving this association is not meaningfully captured by any of the three SDOH indices studied.