1
|
Loman DG, Borgmeyer AE, Henry LD, Mahl CS, Ellis AG. Childhood Asthma Control Test and spirometry values in school-age children. J Asthma 2024; 61:322-327. [PMID: 37851936 DOI: 10.1080/02770903.2023.2272802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To determine the relationship between child and parent reports of asthma control using the Childhood Asthma Control Test (C-ACT) and spirometry. METHODS This descriptive study included 648 children ages 5-11 years from a school-based asthma program. Not well-controlled asthma was defined as forced expiratory volume in 1 s (FEV1) and by FEV1/forced vital capacity (FVC) of 80% predicted or lower. Sensitivity and specificity of C-ACT scores for low FEV1 and FEV1/FVC levels were calculated. Logistic regression was used to obtain the area under the receiver operating characteristic curve (AUC) for C-ACT score categories by FEV1 level. RESULTS Mean child age was 8.2 years, mean C-ACT score was 20.3 (SD = 3.96), mean FEV1 was 94.3% (SD = 17.1), and mean FEV1/FVC was 81.3 (SD = 8.5). Children with an FEV1 of 80% or less had significantly lower C-ACT scores than those with an FEV1 > 80% (p = .023, t = -2.015, df = 167); 95% CI [. -1.79 to -0.018]). The sensitivity and specificity of a C-ACT score of 19 or less for an FEV1 of 80% predicted or lower were 44.9 and 66.4%. With a C-ACT score of 22 or less, sensitivity and specificity for low FEV1 were 67.7 and 30.9%. The AUC for a C-ACT score of 19 or less and FEV1 of 80% or lower was .444 while the AUC was higher at .507 for a CACT score of 22 or less. CONCLUSION The C-ACT is a useful screen but spirometry should be performed in children with persistent symptoms to assess current asthma control.
Collapse
Affiliation(s)
| | | | - Lisa D Henry
- St. Louis Children's Hospital, St. Louis, MO, USA
| | | | - Alysa G Ellis
- Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
2
|
Pongdee T, Brunner WM, Kanuga MJ, Sussman JH, Wi CI, Juhn YJ. Rural Health Disparities in Allergy, Asthma, and Immunologic Diseases: The Current State and Future Direction for Clinical Care and Research. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:334-344. [PMID: 38013156 PMCID: PMC11089647 DOI: 10.1016/j.jaip.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/06/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
Rural health disparities are well documented and continue to jeopardize the long-term health and wellness for the millions of individuals who live in rural America. The disparities observed between urban and rural residents encompass numerous morbidity and mortality measures for several chronic diseases and have been referred to as the "rural mortality penalty." Although the unmet health needs of rural communities are widely acknowledged, little is known about rural health disparities in allergies, asthma, and immunologic diseases. Furthermore, the intersection between rural health disparities and social determinants of health has not been fully explored. To achieve a more complete understanding of the factors that perpetuate rural health disparities, greater research efforts followed by improved practice and policy are needed that account for the complex social context within rural communities rather than a general comparison between urban and rural environments or focusing on biomedical factors. Moreover, research efforts must prioritize community inclusion throughout rural areas through meaningful engagement of stakeholders in both clinical care and research. In this review, we examine the scope of health disparities in the rural United States and the impact of social determinants of health. We then detail the current state of rural health disparities in the field of allergy, asthma, and immunology. To close, we offer future considerations to address knowledge gaps and unmet needs for both clinical care and research in addressing rural health disparities.
Collapse
Affiliation(s)
- Thanai Pongdee
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn.
| | - Wendy M Brunner
- Center for Rural Community Health, Bassett Research Institute, Bassett Medical Center, Cooperstown, NY
| | - Mansi J Kanuga
- Division of Allergic Diseases, Mayo Clinic Health System, Red Wing, Minn
| | | | - Chung-Il Wi
- Precision Population Science Lab, Mayo Clinic, Rochester, Minn; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn
| | - Young J Juhn
- Precision Population Science Lab, Mayo Clinic, Rochester, Minn; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Office of Mayo Clinic Health System Research, Mayo Clinic Health System, Rochester, Minn.
| |
Collapse
|
3
|
Ojo RO, Okobi OE, Ezeamii PC, Ezeamii VC, Nwachukwu EU, Gebeyehu YH, Okobi E, David AB, Akinsola Z. Epidemiology of Current Asthma in Children Under 18: A Two-Decade Overview Using National Center for Health Statistics (NCHS) Data. Cureus 2023; 15:e49229. [PMID: 38143602 PMCID: PMC10739102 DOI: 10.7759/cureus.49229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
OBJECTIVE This study conducted a comprehensive two-decade analysis of current asthma among children under 18 in the United States using National Center for Health Statistics (NCHS) data. The primary objective was to assess the prevalence of current asthma, evaluate temporal trends, and identify disparities based on gender, age, insurance status, household poverty levels, and race/ethnicity. METHODS Data spanning 2003-2019 from NCHS were analyzed, focusing on current asthma prevalence among children under 18. Age-adjusted prevalence rates were calculated and stratified by various factors, including gender, age groups, health insurance status, poverty levels, and race/ethnicity. RESULTS The study revealed substantial disparities in current asthma prevalence. Over the two-decade period, the overall prevalence of current asthma fluctuated. It increased from 2003 (8.5%) to 2009 (9.6%) and then decreased by 2019 (7.0%). Gender disparities were evident, with males (9.9%) consistently reporting a higher prevalence than females (7.5%). Older children aged between 10-17 years (10.4%) consistently had a higher prevalence of asthma than younger children aged 0-4 (5.3%) and 5-9 years (9.5%). Children with Medicaid insurance (11.2%) had the highest prevalence, followed by insured (8.9%), privately insured (7.7%), and uninsured children (6.1%). Children living below the federal poverty level (FPL) consistently reported the highest prevalence (11.3%), while children above 400% of the FPL (7.1%) had the lowest prevalence. Racial disparities were observed, with Black children (14.3%) having higher asthma prevalence, followed by White (7.6%) and Asian children (5.4%). CONCLUSION The study highlights significant disparities in current asthma prevalence over the two-decade period analyzed. While the overall prevalence showed fluctuations, it generally increased from 2003 to 2009 and then decreased by 2019. Gender disparities were evident, with males consistently reporting a higher prevalence compared to females. Older children in the 10-17 age group consistently had a higher asthma prevalence than younger age groups. Moreover, disparities based on insurance status and income levels were also apparent, with children on Medicaid and those living below the FPL reporting higher asthma prevalence. Racial disparities were observed, with Black children having the highest prevalence, followed by White and Asian children. These findings emphasize the importance of addressing these disparities and tailoring interventions to improve asthma management and prevention across different demographic groups.
Collapse
Affiliation(s)
- Rhoda O Ojo
- Epidemiology and Biostatistics, University of Texas Health Science Center at Houston, Houston, USA
| | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Patra C Ezeamii
- Epidemiology and Public Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, USA
| | - Victor C Ezeamii
- Epidemiology and Public Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, USA
| | | | | | - Emeka Okobi
- Dentistry, Ahmadu Bello University Teaching Hospital, Zaria, NGA
| | | | - Zainab Akinsola
- Internal Medicine/ Family Medicine, Windsor University School of Medicine, Toronto, CAN
| |
Collapse
|
4
|
Sharma R, Humphrey JL, Frueh L, Kinnee EJ, Sheffield PE, Clougherty JE. Neighborhood violence and socioeconomic deprivation influence associations between acute air pollution and temperature on childhood asthma in New York city. ENVIRONMENTAL RESEARCH 2023; 231:116235. [PMID: 37244495 PMCID: PMC10364588 DOI: 10.1016/j.envres.2023.116235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 05/29/2023]
Abstract
Ambient air pollution, temperature, and social stressor exposures are linked with asthma risk, with potential synergistic effects. We examined associations for acute pollution and temperature exposures, with modification by neighborhood violent crime and socioeconomic deprivation, on asthma morbidity among children aged 5-17 years year-round in New York City. Using conditional logistic regression in a time-stratified, case-crossover design, we quantified percent excess risk of asthma event per 10-unit increase in daily, residence-specific exposures to PM2.5, NO2, SO2, O3, and minimum daily temperature (Tmin). Data on 145,834 asthma cases presenting to NYC emergency departments from 2005 to 2011 were obtained from the New York Statewide Planning and Research Cooperative System (SPARCS). Residence- and day-specific spatiotemporal exposures were assigned using the NYC Community Air Survey (NYCCAS) spatial data and daily EPA pollution and NOAA weather data. Point-level NYPD violent crime data for 2009 (study midpoint) was aggregated, and Socioeconomic Deprivation Index (SDI) scores assigned, by census tract. Separate models were fit for each pollutant or temperature exposure for lag days 0-6, controlling for co-exposures and humidity, and mutually-adjusted interactions (modification) by quintile of violent crime and SDI were assessed. We observed stronger main effects for PM2.5 and SO2 in the cold season on lag day 1 [4.90% (95% CI: 3.77-6.04) and 8.57% (5.99-11.21), respectively]; Tmin in the cold season on lag day 0 [2.26% (1.25-3.28)]; and NO2 and O3 in the warm season on lag days 1 [7.86% (6.66-9.07)] and 2 [4.75% (3.53-5.97)], respectively. Violence and SDI modified the main effects in a non-linear manner; contrary to hypotheses, we found stronger associations in lower-violence and -deprivation quintiles. At very high stressor exposures, although asthma exacerbations were highly prevalent, pollution effects were less apparent-suggesting potential saturation effects in socio-environmental synergism.
Collapse
Affiliation(s)
- Rachit Sharma
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Jamie L Humphrey
- Center for Health Analytics, Media & Policy, RTI International, Research Triangle Park, NC, USA
| | - Lisa Frueh
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Ellen J Kinnee
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Perry E Sheffield
- Department of Environmental Medicine and Public Health, and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jane E Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
5
|
Tyris J, Keller S, Parikh K, Gourishankar A. Population-level SDOH and Pediatric Asthma Health Care Utilization: A Systematic Review. Hosp Pediatr 2023; 13:e218-e237. [PMID: 37455665 DOI: 10.1542/hpeds.2022-007005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
CONTEXT Spatial analysis is a population health methodology that can determine geographic distributions of asthma outcomes and examine their relationship to place-based social determinants of health (SDOH). OBJECTIVES To systematically review US-based studies analyzing associations between SDOH and asthma health care utilization by geographic entities. DATA SOURCES Pubmed, Medline, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature. STUDY SELECTION Empirical, observational US-based studies were included if (1) outcomes included asthma-related emergency department visits or revisits, and hospitalizations or rehospitalizations; (2) exposures were ≥1 SDOH described by the Healthy People (HP) SDOH framework; (3) analysis occurred at the population-level using a geographic entity (eg, census-tract); (4) results were reported separately for children ≤18 years. DATA EXTRACTION Two reviewers collected data on study information, demographics, geographic entities, SDOH exposures, and asthma outcomes. We used the HP SDOH framework's 5 domains to organize and synthesize study findings. RESULTS The initial search identified 815 studies; 40 met inclusion criteria. Zip-code tabulation areas (n = 16) and census-tracts (n = 9) were frequently used geographic entities. Ten SDOH were evaluated across all HP domains. Most studies (n = 37) found significant associations between ≥1 SDOH and asthma health care utilization. Poverty and environmental conditions were the most often studied SDOH. Eight SDOH-poverty, higher education enrollment, health care access, primary care access, discrimination, environmental conditions, housing quality, and crime - had consistent significant associations with asthma health care utilization. CONCLUSIONS Population-level SDOH are associated with asthma health care utilization when evaluated by geographic entities. Future work using similar methodology may improve this research's quality and utility.
Collapse
Affiliation(s)
- Jordan Tyris
- Children's National Hospital, Washington, District of Columbia; and Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Susan Keller
- Children's National Hospital, Washington, District of Columbia; and Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Kavita Parikh
- Children's National Hospital, Washington, District of Columbia; and Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Anand Gourishankar
- Children's National Hospital, Washington, District of Columbia; and Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| |
Collapse
|
6
|
Lucas JA, Marino M, Bailey SR, Hsu A, Datta R, Cottrell E, Kim YJ, Suglia SF, Bazemore A, Heintzman J. Comparison of associations of household-level and neighbourhood-level poverty markers with paediatric asthma care utilisation by race/ethnicity in an open cohort of community health centre patients. Fam Med Community Health 2023; 11:e001760. [PMID: 37524521 PMCID: PMC10391793 DOI: 10.1136/fmch-2022-001760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE The objective of this research was to examine how different measurements of poverty (household-level and neighborhood-level) were associated with asthma care utilisation outcomes in a community health centre setting among Latino, non-Latino black and non-Latino white children. DESIGN, SETTING AND PARTICIPANTS We used 2012-2017 electronic health record data of an open cohort of children aged <18 years with asthma from the OCHIN, Inc. network. Independent variables included household-level and neighborhood-level poverty using income as a percent of federal poverty level (FPL). Covariate-adjusted generalised estimating equations logistic and negative binomial regression were used to model three outcomes: (1) ≥2 asthma visits/year, (2) albuterol prescription orders and (3) prescription of inhaled corticosteroids over the total study period. RESULTS The full sample (n=30 196) was 46% Latino, 26% non-Latino black, 31% aged 6-10 years at first clinic visit. Most patients had household FPL <100% (78%), yet more than half lived in a neighbourhood with >200% FPL (55%). Overall, neighbourhood poverty (<100% FPL) was associated with more asthma visits (covariate-adjusted OR 1.26, 95% CI 1.12 to 1.41), and living in a low-income neighbourhood (≥100% to <200% FPL) was associated with more albuterol prescriptions (covariate-adjusted rate ratio 1.07, 95% CI 1.02 to 1.13). When stratified by race/ethnicity, we saw differences in both directions in associations of household/neighbourhood income and care outcomes between groups. CONCLUSIONS This study enhances understanding of measurements of race/ethnicity differences in asthma care utilisation by income, revealing different associations of living in low-income neighbourhoods and households for Latino, non-Latino white and non-Latino black children with asthma. This implies that markers of family and community poverty may both need to be considered when evaluating the association between economic status and healthcare utilisation. Tools to measure both kinds of poverty (family and community) may already exist within clinics, and can both be used to better tailor asthma care and reduce disparities in primary care safety net settings.
Collapse
Affiliation(s)
- Jennifer A Lucas
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Audree Hsu
- California University of Science and Medicine, Colton, California, USA
| | - Roopradha Datta
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Ye Ji Kim
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
- OCHIN Inc, Portland, Oregon, USA
| |
Collapse
|
7
|
Antoñón M, Pernía-Sánchez JV, Cancho-Soto T, Segovia-Molina I, Díez-Monge N, Cano A. Asthma control in children, socioeconomic inequality and health care. An Pediatr (Barc) 2023; 98:353-361. [PMID: 37055301 DOI: 10.1016/j.anpede.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/29/2022] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Socioeconomic inequality (SEI) can adversely affect asthma control. The aim of this study was to establish the association of SEI with asthma control in children and caregiver quality of life. METHODS We assessed socioeconomic status based on the area of residence, according to the at risk of poverty rate (ARPR). After stratifying the paediatric population of Castilla y León (Spain) in ARPR tertiles, we selected participants by stratified random sampling, and identified children with asthma aged 6-14 years from the health records of primary care centres. We collected data through questionnaires completed by parents. The primary outcomes were asthma control and caregiver quality of life. We assessed their association with SEI, health care quality measures and individual factors (such as parental educational attainment) by means of multivariate regression models. RESULT The ARPR tertile was not associated with asthma control, quality of life or health care quality. A medium or high maternal educational attainment was associated with a lower risk of making an unscheduled or urgent visit (OR = .50; 95% CI, .27-.95; P = .034) and paternal educational attainment was associated with a lower risk of uncontrolled asthma (OR = 0.51; 95% CI, .28-.94; P = .030). CONCLUSION In the sample under study, SEI assessed at the local level was not associated with asthma control in children. Other factors, such as parental educational attainment, may have a protective effect.
Collapse
Affiliation(s)
- Miguel Antoñón
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - Teresa Cancho-Soto
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Inés Segovia-Molina
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Nuria Díez-Monge
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain; Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Alfredo Cano
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain; Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain.
| |
Collapse
|
8
|
What Have Mechanistic Studies Taught Us About Childhood Asthma? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:684-692. [PMID: 36649800 DOI: 10.1016/j.jaip.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
Childhood asthma is a chronic heterogeneous syndrome consisting of different disease entities or phenotypes. The immunologic and cellular processes that occur during asthma development are still not fully understood but represent distinct endotypes. Mechanistic studies have examined the role of gene expression, protein levels, and cell types in early life development and the manifestation of asthma, many under the influence of environmental stimuli, which can be both protective and risk factors for asthma. Genetic variants can regulate gene expression, controlled partly by different epigenetic mechanisms. In addition, environmental factors, such as living space, nutrition, and smoking, can contribute to these mechanisms. All of these factors produce modifications in gene expression that can alter the development and function of immune and epithelial cells and subsequently different trajectories of childhood asthma. These early changes in a partially immature immune system can have dramatic effects (e.g., causing dysregulation), which in turn contribute to different disease endotypes and may help to explain differential responsiveness to asthma treatment. In this review, we summarize published studies that have aimed to uncover distinct mechanisms in childhood asthma, considering genetics, epigenetics, and environment. Moreover, a discussion of new, powerful tools for single-cell immunologic assays for phenotypic and functional analysis is included, which promise new mechanistic insights into childhood asthma development and therapeutic and preventive strategies.
Collapse
|
9
|
Control del asma en niños, desigualdad socioeconómica y asistencia sanitaria. An Pediatr (Barc) 2023. [DOI: 10.1016/j.anpedi.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
|
10
|
Coker TR, Mitchell SJ, Lowry SJ, Klein EJ, Stout JW, Brown JC, Liljenquist KS, Wingfield E, Horn IB. Text2Breathe: Text-Message Intervention for Parent Communication and Pediatric Asthma. Acad Pediatr 2023; 23:123-129. [PMID: 35577281 PMCID: PMC10650351 DOI: 10.1016/j.acap.2022.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/04/2022] [Accepted: 05/07/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Mobile health technology offers promise for reducing disparities in pediatric asthma care and outcomes by helping parents more effectively communicate with their children's primary care providers and manage their children's asthma. This study tested the impact of a text messaging program on emergency department utilization and asthma morbidity. METHODS A randomized controlled trial enrolled 221 parents of Medicaid-insured children visiting the emergency departments of 2 urban children's hospitals in the Pacific Northwest for an asthma-related concern between September 2015 and February 2019. Standardized surveys were administered to parents at baseline and 12 months later to assess the primary outcomes of emergency department utilization and morbidity as well as primary care utilization, parent communication self-efficacy, and asthma self-management knowledge. The intervention group received brief in-person education on partnering with primary care providers, followed by 3 months of educational text messages. RESULTS Participants were mostly female, English speakers, of minority race and ethnicity, and living below 200% of the federal poverty level. Negative binomial and linear regressions indicated no significant group differences in annual number of emergency department visits, morbidity, parent communication self-efficacy, or asthma self-management knowledge at 12 months' follow-up, adjusting for baseline covariates. Average annual rate of primary care visits for asthma was 35% higher in the intervention group compared to control group at follow-up (95% confidence interval 1.03-1.76, P = .03). CONCLUSIONS This parent-focused text message intervention did not impact emergency department utilization or asthma morbidity; however, results suggest its potential for enhancing use of primary care for management of pediatric chronic conditions.
Collapse
Affiliation(s)
- Tumaini R Coker
- Division of General Pediatrics, University of Washington School of Medicine (TR Coker, JW Stout, and KS Liljenquist), Seattle, Wash; Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash
| | - Stephanie J Mitchell
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash.
| | - Sarah J Lowry
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash
| | - Eileen J Klein
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash; Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine (EJ Klein and J Brown), Seattle, Wash
| | - James W Stout
- Division of General Pediatrics, University of Washington School of Medicine (TR Coker, JW Stout, and KS Liljenquist), Seattle, Wash; Department of Health Services, University of Washington (JW Stout and KS Liljenquist), Seattle, Wash
| | - Julie C Brown
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash; Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine (EJ Klein and J Brown), Seattle, Wash
| | - Kendra S Liljenquist
- Division of General Pediatrics, University of Washington School of Medicine (TR Coker, JW Stout, and KS Liljenquist), Seattle, Wash; Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash; Department of Health Services, University of Washington (JW Stout and KS Liljenquist), Seattle, Wash
| | - Elizabeth Wingfield
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash
| | - Ivor B Horn
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash
| |
Collapse
|
11
|
Kim Y, Parrish KM, Pirritano M, Moonie S. A higher Asthma Medication Ratio (AMR) predicts a decrease in ED visits among African American and Hispanic children. J Asthma 2022; 60:1428-1437. [PMID: 36461904 DOI: 10.1080/02770903.2022.2155183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Higher rates of ED visits and hospitalizations for asthma among African American and Hispanic children may indicate suboptimal management of asthma, leading to a greater financial burden of healthcare. It is not well known if an association of race/ethnicity with controller medication and hospital-based care utilization exists. OBJECTIVE This study examines whether the Asthma Medication Ratio (AMR) predicts healthcare utilization for asthma by race/ethnicity. METHODS 4,584 Medi-Cal children (Ages 5-11) with persistent asthma in Los Angeles were identified and their AMRs (2018) were calculated based on the HEDIS criteria. Healthcare utilization data were used, including hospitalizations, ED visits, and pharmacy claims to examine whether a higher AMR predicts decreases in healthcare utilization by race/ethnicity in the subsequent 3,6, and 12 months (2019). RESULTS The average AMR was lowest among African American children (0.401). In the subsequent 12 months, they were highest in ED visits (0.249) and hospitalizations (0.121), but lowest in outpatient visits (0.793). The results of logistic regression showed that a higher value of AMR (>0.5) contributed to decreases in ED visits in the subsequent 12 months only among African Americans (OR = 0.551, 95% CI 0.364-0.832) and Hispanics (OR = 0.613, 95% CI 0.489-0.770). No association between AMR and hospitalizations was found. CONCLUSIONS Our findings indicate that increased use of controller medication contributes to a decrease in ED visits among African American and Hispanic children with persistent asthma. Increased use of controller medications and caregiver's efforts for medication adherence may contribute to a reduction in asthma disparities.
Collapse
Affiliation(s)
- Yonsu Kim
- University of Nevada, Las Vegas, NV, USA
| | | | | | | |
Collapse
|
12
|
Ludden T, O’Hare K, Shade L, Reeves K, Patterson CG, Tapp H. Implementation of Coach McLungsSM into primary care using a cluster randomized stepped wedge trial design. BMC Med Inform Decis Mak 2022; 22:285. [PMID: 36333727 PMCID: PMC9636750 DOI: 10.1186/s12911-022-02030-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
Abstract
Background Asthma is a prevalent chronic disease that is difficult to manage and associated with marked disparities in outcomes. One promising approach to addressing disparities is shared decision making (SDM), a method by which the patient and provider cooperatively make a decision about asthma care. SDM is associated with improved outcomes for patients; however, time constraints and staff availability are noted implementation barriers. Use of health information technology (IT) solutions may facilitate the utilization of SDM. Coach McLungsSM is a collaborative web-based application that involves pediatric patients, their caregivers, and providers in a personalized experience while gathering patient-reported data. Background logic provides decision support so both audiences can develop a well-informed treatment plan together. The goal of this study is to evaluate the implementation of the Coach McLungsSM intervention into primary care. Methods Implementation will be evaluated using a stepped wedge randomized control study design at 21 pediatric and family medicine practices within a large, integrated, nonprofit healthcare system. We will measure changes in emergency department visits, hospitalizations, and oral steroid use, which serve as surrogate measures for patient-centered asthma outcomes. We will use a generalized linear mixed models with logit link to test the hypothesis for the reduction in exacerbation rates specifying the fixed effects of intervention and time and random effects for practice and practice*time. This design achieves 84% power to detect the hypothesized effect size difference of 10% in overall exacerbation between control (40%) and intervention (30%) periods (two-sided, p = 0.05). Implementation will be guided using the Expert Recommendations for Implementing Change (ERIC), a compilation of implementation strategies, and evaluated using the CFIR (Consolidated Framework for Implementation Research) and RE-AIM (Reach Effectiveness, Adoption, Implementation, Maintenance). Discussion We anticipate that a tailored implementation of Coach McLungsSM across diverse primary care practices will lead to a decrease in emergency department visits, hospitalizations, and oral steroid use for patients in the intervention group as compared to the control condition. Trial Registration: Clincaltrials.gov, NCT05059210. Registered 28 September 2021, https://www.clinicaltrials.gov/ct2/show/NCT05059210 Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-02030-1.
Collapse
|
13
|
Okelo SO. Racial Inequities in Asthma Care. Semin Respir Crit Care Med 2022; 43:684-708. [DOI: 10.1055/s-0042-1756492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractRacial inequities in asthma care are evolving as a recognized factor in long-standing inequities in asthma outcomes (e.g., hospitalization and mortality). Little research has been conducted regarding the presence or absence of racial inequities among patients seen in asthma specialist settings, this is an important area of future research given that asthma specialist care is recommended for patients experiencing the poor asthma outcomes disproportionately experienced by Black and Hispanic patients. This study provides a systematic review of racial asthma care inequities in asthma epidemiology, clinical assessment, medication prescription, and asthma specialist referral practices.
Collapse
Affiliation(s)
- Sande O. Okelo
- Division of Pediatric Pulmonology and Sleep Medicine, The David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| |
Collapse
|
14
|
Zanobetti A, Ryan PH, Coull B, Brokamp C, Datta S, Blossom J, Lothrop N, Miller RL, Beamer PI, Visness CM, Andrews H, Bacharier LB, Hartert T, Johnson CC, Ownby D, Khurana Hershey GK, Joseph C, Yiqiang S, Mendonça EA, Jackson DJ, Luttmann-Gibson H, Zoratti EM, Wright AL, Martinez FD, Seroogy CM, Gern JE, Gold DR. Childhood Asthma Incidence, Early and Persistent Wheeze, and Neighborhood Socioeconomic Factors in the ECHO/CREW Consortium. JAMA Pediatr 2022; 176:759-767. [PMID: 35604671 PMCID: PMC9127710 DOI: 10.1001/jamapediatrics.2022.1446] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/10/2021] [Indexed: 02/02/2023]
Abstract
Importance In the United States, Black and Hispanic children have higher rates of asthma and asthma-related morbidity compared with White children and disproportionately reside in communities with economic deprivation. Objective To determine the extent to which neighborhood-level socioeconomic indicators explain racial and ethnic disparities in childhood wheezing and asthma. Design, Setting, and Participants The study population comprised children in birth cohorts located throughout the United States that are part of the Children's Respiratory and Environmental Workgroup consortium. Cox proportional hazard models were used to estimate hazard ratios (HRs) of asthma incidence, and logistic regression was used to estimate odds ratios of early and persistent wheeze prevalence accounting for mother's education, parental asthma, smoking during pregnancy, child's race and ethnicity, sex, and region and decade of birth. Exposures Neighborhood-level socioeconomic indicators defined by US census tracts calculated as z scores for multiple tract-level variables relative to the US average linked to participants' birth record address and decade of birth. The parent or caregiver reported the child's race and ethnicity. Main Outcomes and Measures Prevalence of early and persistent childhood wheeze and asthma incidence. Results Of 5809 children, 46% reported wheezing before age 2 years, and 26% reported persistent wheeze through age 11 years. Asthma prevalence by age 11 years varied by cohort, with an overall median prevalence of 25%. Black children (HR, 1.47; 95% CI, 1.26-1.73) and Hispanic children (HR, 1.29; 95% CI, 1.09-1.53) were at significantly increased risk for asthma incidence compared with White children, with onset occurring earlier in childhood. Children born in tracts with a greater proportion of low-income households, population density, and poverty had increased asthma incidence. Results for early and persistent wheeze were similar. In effect modification analysis, census variables did not significantly modify the association between race and ethnicity and risk for asthma incidence; Black and Hispanic children remained at higher risk for asthma compared with White children across census tracts socioeconomic levels. Conclusions and Relevance Adjusting for individual-level characteristics, we observed neighborhood socioeconomic disparities in childhood wheeze and asthma. Black and Hispanic children had more asthma in neighborhoods of all income levels. Neighborhood- and individual-level characteristics and their root causes should be considered as sources of respiratory health inequities.
Collapse
Affiliation(s)
- Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Patrick H. Ryan
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Brent Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Cole Brokamp
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Soma Datta
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey Blossom
- Center for Geographic Analysis, Harvard University, Cambridge, Massachusetts
| | - Nathan Lothrop
- Asthma and Airways Disease Research Center, University of Arizona, Tucson
- Department of Community, Environment, and Policy, Mel and Enic Zuckerman College of Public Health, University of Arizona, Tucson
| | - Rachel L. Miller
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paloma I. Beamer
- Asthma and Airways Disease Research Center, University of Arizona, Tucson
- Department of Community, Environment, and Policy, Mel and Enic Zuckerman College of Public Health, University of Arizona, Tucson
| | | | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Leonard B. Bacharier
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Monroe Carell Jr Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Tina Hartert
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Christine C. Johnson
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Dennis Ownby
- Division of Allergy and Immunology, Augusta University, Augusta, Georgia
| | | | - Christine Joseph
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Song Yiqiang
- Indiana University School of Medicine, Bloomington
| | | | - Daniel J. Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Heike Luttmann-Gibson
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Anne L. Wright
- Asthma and Airways Disease Research Center, University of Arizona, Tucson
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, College of Medicine, University of Arizona, Tucson
| | - Fernando D. Martinez
- Asthma and Airways Disease Research Center, University of Arizona, Tucson
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, College of Medicine, University of Arizona, Tucson
| | - Christine M. Seroogy
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - James E. Gern
- Department of Medicine, Henry Ford Health System, Detroit, Michigan
| | - Diane R. Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
15
|
Shaw AY, Fiorino AM, Hidrue M, Johnson NY, Miao J, Searl Como J, Spiro A, Cafiero Fonseca ET, Wasfy JH, Arauz Boudreau A. Implementation of a Pediatric Population Health Asthma Program in Academic Medical Center-Affiliated Urban and Suburban Practices. Popul Health Manag 2022; 25:608-615. [PMID: 35666212 DOI: 10.1089/pop.2021.0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A tiered pediatric Asthma Population Health Management Program (APHMP), based on evidence-based practices, that differentially targets populations for intervention based on rising risk for high utilization and disease complications was implemented at 6 urban and suburban practices affiliated with an academic medical center. In addition to standard pediatric asthma care, APHMP adds regular administration of the asthma control test (ACT), provider education on performance variation, and monitoring through the electronic health record-based asthma registry. As patients' use of acute health care services and complications increases, APHMP integrates multidisciplinary interventions, including an asthma coach who conducts environmental assessments in addition to addressing social needs, into their primary care. A retrospective cohort study method was used to assess population-level effects on asthma event rates and practice- and provider-level variation from 2017 to 2019. Consistent with well-documented health disparities in pediatric asthma, the analysis demonstrated that patients who were male (odds ratio [OR] = 1.21, 95% confidence interval [CI] = 1.02-1.43), 4-8 years old (OR = 4.91, 95% CI = 3.27-7.37), Spanish speaking (OR = 1.67, 95% CI = 1.54-1.81), from low-income neighborhoods (OR = 1.56, 95% CI = 1.53-2.46), and with ACT <20 (OR = 2.88, 95% CI = 1.97-4.21) had higher odds of having asthma events. Six percent of patients studied were found to be at risk for high health care utilization and disease complications. Study limitations include the absence of a control group, the mixed model data collection approach, and the effects of seasonal variation on asthma events. Future directions include analyzing disease management program outcomes of incorporating an asthma coach into a patient's primary care team and addressing provider-level variation in asthma event rates.
Collapse
Affiliation(s)
- Ashley Y Shaw
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anne-Maria Fiorino
- Population Health Management, Performance Analysis and Improvement Department, Massachusetts General Hospital, Massachusetts General Hospital Physicians' Organization, Boston, Massachusetts, USA
| | - Michael Hidrue
- Massachusetts General Hospital Physicians' Organization, Boston, Massachusetts, USA
| | - Natalie Y Johnson
- Office of Equity and Community Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joanne Miao
- Population Health Management, Performance Analysis and Improvement Department, Massachusetts General Hospital, Massachusetts General Hospital Physicians' Organization, Boston, Massachusetts, USA
| | - Jennifer Searl Como
- Population Health Management, Performance Analysis and Improvement Department, Massachusetts General Hospital, Massachusetts General Hospital Physicians' Organization, Boston, Massachusetts, USA
| | - Anna Spiro
- Community Health Improvement, Massachusetts General Hospital Chelsea Health Center, Chelsea, Massachusetts, USA
| | - Elizabeth T Cafiero Fonseca
- Population Health Management, Performance Analysis and Improvement Department, Massachusetts General Hospital, Massachusetts General Hospital Physicians' Organization, Boston, Massachusetts, USA
| | - Jason H Wasfy
- Harvard Medical School, Boston, Massachusetts, USA.,Population Health Management, Performance Analysis and Improvement Department, Massachusetts General Hospital, Massachusetts General Hospital Physicians' Organization, Boston, Massachusetts, USA.,Massachusetts General Hospital Physicians' Organization, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alexy Arauz Boudreau
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
16
|
Kub JE, DePriest KN, Bellin MH, Butz A, Lewis-Land C, Morphew T. Predictors of Depressive Symptoms in Caregivers of Children With Poorly Controlled Asthma: Is the Neighborhood Context Important? FAMILY & COMMUNITY HEALTH 2022; 45:10-22. [PMID: 34783687 PMCID: PMC9600613 DOI: 10.1097/fch.0000000000000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Children residing in low-income neighborhoods are disproportionately affected by asthma morbidity and mortality. Neighborhood violence has been explored in relationship to child morbidity and health and developmental outcomes, but less is known about the relationship of violence to caregiver mental health. The purpose of this study was to examine the relationship of neighborhood violent crime victimization (objective and subjective measures), perceptions of community well-being and support, and depressive symptoms among a sample of primarily single female caregivers of children with uncontrolled asthma. This is a secondary analysis of baseline data obtained from a randomized controlled trial of a home-based environmental control intervention for children aged 3 to 12 years, who were primarily African American, and diagnosed with persistent, uncontrolled asthma. Results showed that both objective and subjective measures of crime, particularly in those with relatively low life stress (P < .001), limited education of the caregiver (P < .001), and fewer children (P < .01) in the household had direct associations with depressive symptoms in caregivers of children with uncontrolled asthma. Neighborhood perceptions of satisfaction and a sense of community, as well as perceptions of social support, were not associated with depressive symptoms. Our findings emphasize the need to screen for depressive symptoms, life stress, as well as both objective and subjective perceptions of neighborhood violence among caregivers of children with poorly controlled asthma. Furthermore, when providing holistic care to these caregivers, stress reduction and the provision of mental health resources are paramount.
Collapse
Affiliation(s)
- Joan E Kub
- Johns Hopkins University School of Nursing, Baltimore, Maryland (Drs Kub and DePriest); University of Maryland School of Social Work, Baltimore (Dr Bellin); Department of Pediatrics (Dr Butz) and Institute for Clinical & Translation Research (Ms Lewis-Land), Johns Hopkins University School of Medicine, Baltimore, Maryland; and Morphew Consulting, LLC, Bothell, Washington (Ms Morphew)
| | | | | | | | | | | |
Collapse
|
17
|
A distributed geospatial approach to describe community characteristics for multisite studies. J Clin Transl Sci 2021; 5:e86. [PMID: 34007469 PMCID: PMC8111696 DOI: 10.1017/cts.2021.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Understanding place-based contributors to health requires geographically and culturally diverse study populations, but sharing location data is a significant challenge to multisite studies. Here, we describe a standardized and reproducible method to perform geospatial analyses for multisite studies. Using census tract-level information, we created software for geocoding and geospatial data linkage that was distributed to a consortium of birth cohorts located throughout the USA. Individual sites performed geospatial linkages and returned tract-level information for 8810 children to a central site for analyses. Our generalizable approach demonstrates the feasibility of geospatial analyses across study sites to promote collaborative translational research.
Collapse
|
18
|
Spray J, Carter CR, Waters EA, Hunleth JM. Not Breathing Easy: "Disarticulated Homework" in Asthma Management. Med Anthropol Q 2021; 35:285-302. [PMID: 33502761 DOI: 10.1111/maq.12628] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/13/2020] [Accepted: 10/19/2020] [Indexed: 12/14/2022]
Abstract
Recent health policy in the United States encourages an outsourcing of labor from professional practice into domestic spaces, where in theory, medical professionals supply the training, technologies, and guidance needed to discharge responsibility for care to patients or caregivers. Mattingly et al. (2011) term this labor "chronic homework," describing the relationship between the assigning and undertaking of medical care at the borders of professional and domestic domains. This is a system predicated on relationships between professional and caregiver. However, in our research with families and providers in two U.S. sites, we observed a "disarticulation" of asthma care from professional medicine. Caregivers may undertake routine asthma management with little physician oversight, transforming chronic homework into what we term "disarticulated homework." We argue that expanding the concept of chronic homework to theorize disarticulation processes can help elucidate how health disparities are reproduced in the gap between medical systems and domestic life. [asthma, self-management, caregiving pharmaceuticalization, health disparities].
Collapse
Affiliation(s)
- Julie Spray
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis
| | - Chelsey R Carter
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis
| | - Erika A Waters
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis
| | - Jean M Hunleth
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis
| |
Collapse
|
19
|
Hunleth J, Spray J, Ruiz S, Maki J, Fedele DA, Prabhakaran S, Forsyth RB, Sykes C, Crepps K, Shepperd J, Bowen D, Waters EA. Situating household management of children's asthma in the context of social, economic, and environmental injustice. J Asthma 2020; 59:70-78. [PMID: 33107771 DOI: 10.1080/02770903.2020.1837159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Structural determinants of health are social, economic, and environmental forces that generate unequal opportunities for resources and unequally distribute exposure to risk. For example, economic constraint, racial discrimination and segregation, and environmental injustice shape population-level asthma prevalence and severity. Structural determinants are especially relevant to consider in clinical settings because they affect everyday household asthma management. OBJECTIVE To examine how structural determinants shape everyday household management of pediatric asthma and offer a framework for providers to understand asthma management in social context. DESIGN Qualitative interviews of caregivers for children with asthma. PARTICIPANTS Participants included 41 caregivers in two U.S. cities: St. Louis, Missouri (n = 25) and Gainesville, Florida (n = 16). Most caregivers were women (83%), Black (73%) and/or had low socioeconomic status (SES; 78%). Caregivers cared for children with asthma aged 0-4 (32%), 5-11 (68%) and 12-17 (54%). APPROACH We carried out narrative interviews with caregivers using an adapted McGill Illness Narrative Interview and using qualitative analysis techniques (e.g. inductive and deductive coding, constant comparison). KEY RESULTS Caregivers highlighted three ways that structural determinants complicated asthma management at home: 1) housing situations, 2) competing household illnesses and issues, and 3) multi-household care. CONCLUSIONS By connecting social, economic, and environmental injustices to the everyday circumstances of asthma management, our study can help providers understand how social contexts challenge asthma management and can open conversations about barriers to adherence and strategies for supporting asthma management at home. We offer recommendations for medical system reform, clinical interactions, and policy advocacy.
Collapse
Affiliation(s)
- Jean Hunleth
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Julie Spray
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Sienna Ruiz
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Julia Maki
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | | | - Rachel B Forsyth
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Cassidy Sykes
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Kaylah Crepps
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - James Shepperd
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Deb Bowen
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Erika A Waters
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| |
Collapse
|
20
|
Schatz M, Sicherer SH, Khan DA, Zeiger RS. The Journal of Allergy and Clinical Immunology: In Practice 2019 Highlights. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:912-936. [PMID: 31980411 DOI: 10.1016/j.jaip.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
This article provides highlights of the clinically impactful original studies and reviews published in The Journal of Allergy and Clinical Immunology: In Practice in 2019 on the subjects of anaphylaxis, asthma, dermatitis, drug allergy, food allergy, immunodeficiency, immunotherapy, rhinitis/sinusitis, and urticaria/angioedema/mast cell disorders. Within each topic, practical aspects of diagnosis and management are emphasized. Treatments discussed include lifestyle modifications, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We designed this review to help readers consolidate and use this extensive and practical knowledge for the benefit of their patients.
Collapse
Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
| |
Collapse
|
21
|
Fitzgerald DA. Mini-symposium: Lung diseases in children living in poverty. Paediatr Respir Rev 2019; 32:2. [PMID: 31735597 DOI: 10.1016/j.prrv.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/18/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Dominic A Fitzgerald
- The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child & Adolescent Health, Sydney Medical School, University of Sydney, Australia.
| |
Collapse
|
22
|
Sá-Sousa A, Almeida R, Vicente R, Nascimento N, Martins H, Freitas A, Fonseca JA. High oral corticosteroid exposure and overuse of short-acting beta-2-agonists were associated with insufficient prescribing of controller medication: a nationwide electronic prescribing and dispensing database analysis. Clin Transl Allergy 2019; 9:47. [PMID: 31559008 PMCID: PMC6755705 DOI: 10.1186/s13601-019-0286-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/10/2019] [Indexed: 12/15/2022] Open
Abstract
Background Recurrent use of oral corticosteroids (OCS) and over-use of short-acting beta-2-agonists (SABA) are factors associated with adverse side effects and asthma-related death. We aim to quantify high OCS exposure, SABA over-use and its association with prescription and adherence to maintenance treatment for respiratory disease, among patients with prescriptions for respiratory disease, from the Portuguese electronic prescription and dispensing database (BDNP). Methods This was a 1-year (2016) retrospective population-based analysis of a random sample of adult patients from the BDNP, the nationwide compulsory medication prescription system. We assessed high OCS exposure (dispensing ≥ 4 packages containing 20 doses of 20 mg each of prednisolone-equivalent, ≥ 1600 mg/year) on patients on persistent respiratory treatment (PRT-prescription for > 2 packages of any respiratory maintenance medications). Excessive use of SABA was defined as having a ratio of SABA-to-maintenance treatment > 1 or having SABA over-use (dispensing of > 1 × 200 dose canister/month, of 100 μg of salbutamol-equivalent). Factors associated with high OCS exposure were assessed by multinomial logistic regression. Results The estimated number of patients on PRT was 4786/100,000 patients. OCS was prescribed to more than 1/5 of the patients on PRT and 101/100,000 were exposed to a high-dose (≥ 1600 mg/year). SABA excessive use was found in 144/100,000 patients and SABA over-use in 24/100,000. About 1/6 of SABA over-users were not prescribed any controller medication and 7% of them had a ratio maintenance-to-total ≥ 70% (high prescription of maintenance treatment). Primary adherence (median%) to controller medication was 66.7% for PRT patients, 59.6% for patients exposed to high OCS dose and 75.0% for SABA over-users. High OCS exposure or SABA over-use were not associated with primary adherence. High OCS exposure was associated with a maintenance-to-total medication ratio < 70% (insufficient prescription of maintenance treatment), age > 45 years old and male sex. Conclusions Exposure to high-dose of OCS (101 per 100,000 patients) and SABA over-use (24 per 100,000) were frequent, and were associated with a low maintenance-to-total prescription ratio but not with primary non-adherence. These results suggest there is a need for initiatives to reduce OCS and SABA inappropriate prescribing.
Collapse
Affiliation(s)
- Ana Sá-Sousa
- 1CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rute Almeida
- 1CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ricardo Vicente
- 2SPMS Shared Services of the Ministry of Health, Lisbon, Portugal
| | | | - Henrique Martins
- 2SPMS Shared Services of the Ministry of Health, Lisbon, Portugal
| | - Alberto Freitas
- 1CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,3MEDCIDS-Department of Community Medicine, Information, and Health Decision Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - João Almeida Fonseca
- 1CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,3MEDCIDS-Department of Community Medicine, Information, and Health Decision Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,4Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| |
Collapse
|
23
|
Editor's Spotlight/Take 5: Socioeconomic Status Is Associated with Risk of Above-knee Amputation After Periprosthetic Joint Infection of the Knee. Clin Orthop Relat Res 2019; 477:1528-1530. [PMID: 31135531 PMCID: PMC6999994 DOI: 10.1097/corr.0000000000000805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
24
|
Sullivan PW, Ghushchyan V, Kavati A, Navaratnam P, Friedman HS, Ortiz B. Trends in Asthma Control, Treatment, Health Care Utilization, and Expenditures Among Children in the United States by Place of Residence: 2003-2014. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1835-1842.e2. [PMID: 30772478 DOI: 10.1016/j.jaip.2019.01.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/11/2019] [Accepted: 01/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Examining national trends in asthma treatment and control is essential to inform treatment and public health initiatives. OBJECTIVE Explore national trends in asthma control and treatment over time among children and those residing in poor-urban areas. METHODS This was an analysis of trends from 2003 to 2014 among children (aged 1-17 years) in the Medical Expenditure Panel Survey. Indicators of poor control included use of more than 3 canisters of short-acting β-agonists (SABAs) in 3 months, asthma attack, emergency department/inpatient hospitalization, and systemic corticosteroids. Treatment included inhaled corticosteroids, controller medications, SABAs, and greater than or equal to 0.7 ratio of controller-to-total prescriptions. Other measures included the number of asthma medications, outpatient visits, asthma-specific drug, and total expenditures per-patient-per-year. RESULTS There were 8.4 million children with asthma in the United States in 2014; 11.1% lived in poor-urban areas. There was a statistically significant decrease in the percentage of children using inhaled corticosteroids, controller medications, daily preventive medications, systemic corticosteroids, SABAs, more than 3 canisters of SABAs (in 3 months), overall asthma prescriptions, and outpatient visits. There was a significant increase in the percentage of children reporting having an asthma attack. Trends for children residing in poor-urban areas were compared with all others; however, limited data and variability in annual estimates prevent clear conclusions. CONCLUSIONS Results suggest lack of improvement in treatment and control since 2003 among children with asthma in the United States. There is significant room for improvement in asthma control and disease management among children.
Collapse
Affiliation(s)
| | - Vahram Ghushchyan
- University of Colorado, Denver, Colo; American University of Armenia, Yerevan, Armenia
| | | | | | | | | |
Collapse
|