Geospatial Analysis of Social Determinants of Health Identifies Neighborhood Hot Spots Associated With Pediatric Intensive Care Use for Life-Threatening Asthma.
Geospatial Analysis of Social Determinants of Health Identifies Neighborhood Hot Spots Associated With Pediatric Intensive Care Use for Life-Threatening Asthma.
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DOI：
10.1016/j.jaip.2021.10.065
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发表时间：
2022-04
影响因子：
9.4
通讯作者：
Fitzpatrick, Anne M.
中科院分区：
文献类型：
--
作者：
Grunwell, Jocelyn R.;Opolka, Cydney;Mason, Carrie;Fitzpatrick, Anne M.
关键词：
健康的社会决定因素与哮喘患病率和哮喘儿童的医疗保健利用有关，但是多因素和复杂的。目前尚不清楚社会决定因素是否同样影响病情恶化的严重程度。在1403名因哮喘住进儿科重症监护病房(PICU)的学龄儿童的大型区域队列中，对健康和再入院结果的社会决定因素的综合衡量标准进行了评估。住宅地址被地理编码，并在空间上连接到人口普查区域。对社会脆弱性和儿童机会、PICU再住院率和住院时间的综合衡量标准在社区“热点”之间进行了比较，其中每1000名儿童的PICU住院率达到或超过90%，与非热点地区。228名儿童(16%)居住在附近的热点地区。热点与较高(即较差)的综合社会脆弱性指数排名有关，反映了社会经济状况、家庭构成和残疾以及住房类型和交通工具的差异。热点地区的综合儿童机会指数百分位数排名也较低(即较差)，反映了教育、卫生和环境以及社会和经济领域的差异。较高的社会脆弱性和较低的童年机会与PICU重新入院有关。居住在热点地区还与较长的住院时间、个人住院天数和总的人口普查区域住院天数有关。通过地理空间分析确定的健康的社会决定因素与儿童中更严重的哮喘恶化结局相关。需要针对健康的生物和社会决定因素的门诊战略，以最佳方式照顾和预防哮喘儿童的PICU入院。
Social determinants of health are associated with asthma prevalence and healthcare utilization in children with asthma, but are multifactorial and complex. Whether social determinants similarly influence exacerbation severity is not clear. Composite measures of social determinants of health and readmission outcomes were evaluated in a large regional cohort of 1403 school-age children admitted to a pediatric intensive care unit (PICU) for asthma. Residential addresses were geocoded and spatially joined to census tracts. Composite measures of social vulnerability and childhood opportunity, PICU readmission rates, and hospital length of stay were compared between neighborhood “hot spots,” where PICU admission rates per 1000 children are at or above the 90th percentile, versus non-hot spots. 228 (16%) of children resided within a neighborhood hot spot. Hot spots were associated with a higher (i.e., poorer) composite social vulnerability index ranking, reflecting differences in socioeconomic status, household composition and disability, and housing type and transportation. Hot spots also had a lower (i.e., poorer) composite childhood opportunity index percentile ranking, reflecting differences in the education, health and environment, and social and economic domains. Higher social vulnerability and lower childhood opportunity were associated with PICU readmission. Residing within a hot spot was further associated with a longer duration of hospital stay, individual inpatient bed days, and total census tract inpatient bed days. Social determinants of health identified by geospatial analyses are associated with more severe asthma exacerbation outcomes in children. Outpatient strategies that address both biological and social determinants of health are needed to optimally care for and prevent PICU admissions in children with asthma.
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