BACKGROUND: Bettering Asthma Care in Kids - Geographic Social Determinants Data to Understand Disparities

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Project Summary/Abstract Latino children with asthma have worse outcomes from their asthma than non-Hispanic white children. In the medical literature, the degree to which these outcomes are the result of limited access, underutilization, poor quality of care, or social & environmental factors is unclear. A fuller understanding of asthma outcomes in Latino children is hampered by scientific evidence that has relied upon cross-sectional studies with a limited time capture, or subjective surveys vulnerable to response biases. Additionally, some evidence in the health services literature suggests that social determinants of health (individual- and community-level economic, social, and environmental factors), including Hispanic subgroup (Mexican ancestry, Puerto Rican ancestry, etc) affect asthma care and outcomes. It is uncertain, however, which social determinants are most strongly associated with Latino children's asthma care. The proposed project intends to fill these gaps in knowledge regarding the nature of asthma care disparities in Latino children and the relative contribution of social determinants of health to these disparities, by utilizing an objective, longitudinal, and robust linkage of data sources encompassing thousands of vulnerable children across multiple states. We will leverage a unique data resource from a large, national network of community health centers with shared electronic health record data that is linked to community-level social determinants of health data. This large, longitudinal dataset contains unprecedented data linkages which will let us assess disparities in asthma care, evaluate which social determinants affect utilization and disparities, and determine which of these may do so most significantly over time. We will also specifically develop methods to use community Hispanic subgroup information to estimate the individual subgroups of patient seen in our clinics (which is information not usually present in electronic health records), and how preventive service use differs among these groups Understanding the relative impact of social determinants of health on asthma care in Latino children will: 1. Enable more informed policy decisions to improve the care of this vulnerable population, 2. facilitate strategic partnerships between healthcare providers and community agencies poised to intervene in social factors in the lives of Latino children, and 3. help clinical providers understand their patients' barriers to care utilization, and further point-of-care efforts to address the barriers that influence children's utilization of recommended health care services for their asthma.