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Gaietto K, Han YY, Rosser FJ, Acosta-Pérez E, Forno E, Canino G, Celedón JC. Socioeconomic status, diet, and recurrent severe asthma exacerbations in Puerto Rican youth. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100220. [PMID: 38375461 PMCID: PMC10875262 DOI: 10.1016/j.jacig.2024.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 02/21/2024]
Abstract
Background Why Puerto Rican youths have higher rates of severe asthma exacerbations (SAEs) than their non-Hispanic White peers is unclear. Objective We aimed to identify risk factors associated with recurrent SAEs in Puerto Rican youths with asthma. Methods We performed cross-sectional and longitudinal analyses of recurrent SAEs in 209 Puerto Rican youths with asthma who participated in 2 cross-sectional studies approximately 5.2 years apart: the Puerto Rico Genetics of Asthma and Lifestyle study (visit 1, participants aged 6-14 years) and the Epigenetic Variation and Childhood Asthma in Puerto Ricans study (visit 2, participants aged 9-20 years). Recurrent SAEs were defined as at least 2 SAEs in the previous year. Results Of the youths in our study, there were 80 (38.3%) and 47 (22.4%) with recurrent SAEs at visit 1 and visit 2, respectively, and 31 participants (14.8%) had persistent recurrent SAEs (ie, recurrent SAEs at both visits). In multivariable analyses, low household income was significantly associated with 2.4 to 12.3 times increased odds of recurrent SAEs in all analyses, with stronger longitudinal associations. Low parental education level, nonprivate or employer-based health insurance, overweight or obesity, residential proximity to a major road, and low or moderate level of outdoor activity were each significantly associated with recurrent SAEs in at least 1 analysis. Further, persistence of low parental numeracy level, low household income, and an unhealthy diet were each associated with persistent recurrent SAEs. Conclusion In this study of Puerto Rican youths with asthma, persistence of low parental numeracy level, a low household income, and an unhealthy diet were associated with persistent recurrent SAEs. Our findings support policies promoting equity and healthy lifestyles for Puerto Rican children and their families.
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Affiliation(s)
- Kristina Gaietto
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Yueh-Ying Han
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Franziska J. Rosser
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Edna Acosta-Pérez
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Juan C. Celedón
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
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Beck AF, Seid M, McDowell KM, Udoko M, Cronin SC, Makrozahopoulos D, Powers T, Fairbanks S, Prideaux J, Vaughn LM, Hente E, Thurmond S, Unaka NI. Building a regional pediatric asthma learning health system in support of optimal, equitable outcomes. Learn Health Syst 2024; 8:e10403. [PMID: 38633017 PMCID: PMC11019385 DOI: 10.1002/lrh2.10403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/18/2023] [Accepted: 11/27/2023] [Indexed: 04/19/2024] Open
Abstract
Introduction Asthma is characterized by preventable morbidity, cost, and inequity. We sought to build an Asthma Learning Health System (ALHS) to coordinate regional pediatric asthma improvement activities. Methods We generated quantitative and qualitative insights pertinent to a better, more equitable care delivery system. We used electronic health record data to calculate asthma hospitalization rates for youth in our region. We completed an "environmental scan" to catalog the breadth of asthma-related efforts occurring in our children's hospital and across the region. We supplemented the scan with group-level assessments and focus groups with parents, clinicians, and community partners. We used insights from this descriptive epidemiology to inform the definition of shared aims, drivers, measures, and prototype interventions. Results Greater Cincinnati's youth are hospitalized for asthma at a rate three times greater than the U.S. average. Black youth are hospitalized at a rate five times greater than non-Black youth. Certain neighborhoods bear the disproportionate burden of asthma morbidity. Across Cincinnati, there are many asthma-relevant activities that seek to confront this morbidity; however, efforts are largely disconnected. Qualitative insights highlighted the importance of cross-sector coordination, evidence-based acute and preventive care, healthy homes and neighborhoods, and accountability. These insights also led to a shared, regional aim: to equitably reduce asthma-related hospitalizations. Early interventions have included population-level pattern recognition, multidisciplinary asthma action huddles, and enhanced social needs screening and response. Conclusion Learning health system methods are uniquely suited to asthma's complexity. Our nascent ALHS provides a scaffold atop which we can pursue better, more equitable regional asthma outcomes.
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Affiliation(s)
- Andrew F. Beck
- Division of General & Community PediatricsCincinnati Children'sCincinnatiOhioUSA
- Division of Hospital MedicineCincinnati Children'sCincinnatiOhioUSA
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children'sCincinnatiOhioUSA
- Michael Fisher Child Health Equity CenterCincinnati Children'sCincinnatiOhioUSA
- Office of Population HealthCincinnati Children'sCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Michael Seid
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children'sCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Division of Pulmonary MedicineCincinnati Children'sCincinnatiOhioUSA
| | - Karen M. McDowell
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Division of Pulmonary MedicineCincinnati Children'sCincinnatiOhioUSA
| | - Mfonobong Udoko
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children'sCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Division of Pulmonary MedicineCincinnati Children'sCincinnatiOhioUSA
| | - Susan C. Cronin
- Division of Pulmonary MedicineCincinnati Children'sCincinnatiOhioUSA
| | | | - Tricia Powers
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children'sCincinnatiOhioUSA
| | - Sonja Fairbanks
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children'sCincinnatiOhioUSA
| | - Jonelle Prideaux
- Division of Emergency MedicineCincinnati Children'sCincinnatiOhioUSA
- Qualitative Methods & Analysis CollaborativeCincinnati Children'sCincinnatiOhioUSA
| | - Lisa M. Vaughn
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Division of Emergency MedicineCincinnati Children'sCincinnatiOhioUSA
- Qualitative Methods & Analysis CollaborativeCincinnati Children'sCincinnatiOhioUSA
- Criminal Justice, & Human ServicesUniversity of Cincinnati College of EducationCincinnatiOhioUSA
| | | | - Sophia Thurmond
- Department of Information ServicesCincinnati Children'sCincinnatiOhioUSA
| | - Ndidi I. Unaka
- Division of Hospital MedicineCincinnati Children'sCincinnatiOhioUSA
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children'sCincinnatiOhioUSA
- Michael Fisher Child Health Equity CenterCincinnati Children'sCincinnatiOhioUSA
- Office of Population HealthCincinnati Children'sCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
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3
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Hardy P, Gonzalez M, Lane R, Yonkaitis CF, Pappalardo AA. Stock inhalers for schools: What do schools want and need? Ann Allergy Asthma Immunol 2024; 132:532-534. [PMID: 38081411 DOI: 10.1016/j.anai.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/25/2023]
Affiliation(s)
- Paige Hardy
- Department of Pediatrics, University of Illinois Chicago, Chicago, Illinois; Department of Medicine, University of Illinois Chicago, Chicago, Illinois
| | - Michael Gonzalez
- Department of Pediatrics, University of Illinois Chicago, Chicago, Illinois; Department of Medicine, University of Illinois Chicago, Chicago, Illinois
| | - Rachel Lane
- Center for Clinical and Translational Science, University of Illinois Chicago, Chicago, Illinois
| | - Catherine F Yonkaitis
- Illinois Association of School Nurses, Manteno, Illinois; Department of Population Health Nursing Science, University of Illinois Chicago, Chicago, Illinois
| | - Andrea A Pappalardo
- Department of Pediatrics, University of Illinois Chicago, Chicago, Illinois; Department of Medicine, University of Illinois Chicago, Chicago, Illinois.
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4
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Mendoza-Cano O, Murillo-Zamora E. Assessing the asthma-related burden of disease in Latin American and Caribbean countries: a sociodemographic perspective. Public Health 2024; 227:163-168. [PMID: 38232564 DOI: 10.1016/j.puhe.2023.12.016] [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: 08/01/2023] [Revised: 11/13/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE This study aimed to characterize the burden of asthma-related issues in Latin American and Caribbean countries from 1990 to 2019 and to assess their relationship with the sociodemographic index (SDI). STUDY DESIGN A cross-sectional analysis with an ecological approach was conducted. METHODS The disability-adjusted life years (DALYs) and the SDI data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Linear regression models were used to evaluate the relationship of interest. RESULTS During the study period, a total of 41.7 million DALYs were accounted, with the highest rates observed in children aged under 5 years (651, uncertainty interval [UI]: 369 to 1037 per 100,000) and females (342, UI: 241 to 471 per 100,000). In the multiple regression model based on data from 2019, a significant negative association was observed between the log-transformed DALY rates and the SDI. Specifically, for each unit increase in the SDI, asthma-related DALY rates decreased by an average of 0.97 % (95 % confidence interval: 0.48-1.00 %). CONCLUSIONS This study highlights heterogeneous age, gender, and country-related variations in asthma rates across Latin American and Caribbean countries and emphasizes the influence of sociodemographic factors on its burden.
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Affiliation(s)
- O Mendoza-Cano
- Facultad de Ingeniería Civil, Universidad de Colima, km. 9 Carretera Colima-Coquimatlán, Coquimatlán 28400, Mexico; Centro de Estudios e Investigación en Biocultura, Agroecología, Ambiente y Salud Colima, Ex-Hacienda Nogueras S/N, Nogueras 28450, Mexico.
| | - E Murillo-Zamora
- Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Av. Lapislázuli 250, Col. El Haya, Villa de Álvarez 28984, Mexico.
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Gabbay JM, Abrams EM, Nyenhuis SM, Wu AC. Housing Insecurity and Asthma Outcomes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:327-333. [PMID: 37871647 DOI: 10.1016/j.jaip.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/03/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023]
Abstract
Asthma is a chronic respiratory disease with widespread prevalence that affects children, adolescents, and adults. Asthma morbidity and mortality can be exacerbated in the setting of housing insecurity. In this Grand Rounds Review article, we present a case and discuss the implications that housing insecurity has on asthma outcomes in the United States. We then highlight ways in which providers can advocate for patients with asthma and housing insecurity.
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Affiliation(s)
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - Sharmilee M Nyenhuis
- Department of Pediatrics, Section of Allergy and Immunology, University of Chicago, Chicago, Ill
| | - Ann Chen Wu
- Department of Medicine, Boston Children's Hospital, Boston, Mass; Division of Child Health Research and Policy, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
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Abstract
In the United States, asthma and chronic obstructive pulmonary disease (COPD) disproportionately affect African Americans, Puerto Ricans, and other minority groups. Compared with non-Hispanic whites, minorities have been marginalized and more frequently exposed to environmental risk factors such as tobacco smoke and outdoor and indoor pollutants. Such divergent environmental exposures, alone or interacting with heredity, lead to disparities in the prevalence, morbidity, and mortality of asthma and COPD, which are worsened by lack of access to health care. In this article, we review the burden and risk factors for racial or ethnic disparities in asthma and COPD and discuss future directions in this field.
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Affiliation(s)
- Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Victor E Ortega
- Division of Respiratory Medicine, Department of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Juan C Celedón
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
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Smith BM, Smith TK, Holve S, Connor KA, Coleman C, Tschudy MM. Defining and Promoting Pediatric Pulmonary Health: Equitable Family and Community Partnerships. Pediatrics 2023; 152:e2023062292G. [PMID: 37656028 PMCID: PMC10484323 DOI: 10.1542/peds.2023-062292g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 09/02/2023] Open
Abstract
Optimizing pulmonary health across the lifespan begins from the earliest stages of childhood and requires a partnership between the family, pulmonologist, and pediatrician to achieve equitable outcomes. The Community Pediatrics session of the Defining and Promoting Pediatric Pulmonary Health workshop weaved together 4 community-based pillars with 4 research principles to set an agenda for future pediatric pulmonary research in optimizing lung and sleep health for children and adolescents. To address diversity, equity, and inclusion, both research proposals and workforce must purposefully include a diverse set of participants that reflects the community served, in addition to embracing nontraditional, community-based sites of care and social determinants of health. To foster inclusive, exploratory, and innovative research, studies must be centered on community priorities, with findings applied to all members of the community, particularly those in historically marginalized and minoritized groups. Research teams should also foster meaningful partnerships with community primary care and family members from study conceptualization. To achieve these goals, implementation and dissemination science should be expanded in pediatric pulmonary research, along with the development of rapid mechanisms to disseminate best practices to community-based clinicians. To build cross-disciplinary collaboration and training, community-academic partnerships, family research partnerships, and integrated research networks are necessary. With research supported by community pillars built on authentic partnerships and guided by inclusive principles, pediatric lung and sleep health can be optimized for all children and adolescents across the full lifespan in the community in which they live and thrive.
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Affiliation(s)
- Brandon M. Smith
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tyler K. Smith
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine and Children’s Mercy Kansas City, Kansas City, Missouri
| | - Steve Holve
- Tuba City Regional Health Care, Indian Health Service, Tuba City, Arizona
| | - Katherine A. Connor
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Megan M. Tschudy
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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8
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Gabbay JM, Wu AC. Housing Mobility Intervention and the Impact on Pediatric Asthma Morbidity: A Novel Asthma-Directed Therapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2622-2623. [PMID: 37558365 DOI: 10.1016/j.jaip.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 08/11/2023]
Affiliation(s)
| | - Ann Chen Wu
- Department of Medicine, Boston Children's Hospital, Boston, Mass; Division of Child Health Research and Policy, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
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9
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Margolis RHF, Patel SJ, Krueger J, Brewer T, Williams A, Stringfield S, Teach SJ, Parikh K. Association between social needs and asthma control among children evaluated at a single-center high-risk asthma clinic. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1947-1949.e1. [PMID: 36921799 DOI: 10.1016/j.jaip.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Rachel H F Margolis
- Center for Translational Research, Children's National Research Institute, Washington, DC.
| | - Shilpa J Patel
- Center for Translational Research, Children's National Research Institute, Washington, DC; Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Julie Krueger
- Division of General and Community Pediatrics, Children's National Hospital, Washington, DC
| | - Taylor Brewer
- Center for Translational Research, Children's National Research Institute, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Andrea Williams
- Center for Translational Research, Children's National Research Institute, Washington, DC
| | - Shayla Stringfield
- Center for Translational Research, Children's National Research Institute, Washington, DC
| | - Stephen J Teach
- Center for Translational Research, Children's National Research Institute, Washington, DC; Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Kavita Parikh
- Center for Translational Research, Children's National Research Institute, Washington, DC; Division of Hospital Medicine, Children's National Hospital, Washington, DC
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10
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Treffeisen ER, Wu AC. Will This Toddler Wheeze Again? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1785-1786. [PMID: 37295860 PMCID: PMC10359968 DOI: 10.1016/j.jaip.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Elsa R Treffeisen
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Ann Chen Wu
- Department of Population Medicine, Harvard Medical School; Department of Population Medicine, Harvard Pilgrim Health Care Institute; Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Mass.
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Vo A, Tao Y, Li Y, Albarrak A. The Association Between Social Determinants of Health and Population Health Outcomes: Ecological Analysis. JMIR Public Health Surveill 2023; 9:e44070. [PMID: 36989028 PMCID: PMC10131773 DOI: 10.2196/44070] [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: 11/04/2022] [Revised: 12/21/2022] [Accepted: 02/23/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND With the increased availability of data, a growing number of studies have been conducted to address the impact of social determinants of health (SDOH) factors on population health outcomes. However, such an impact is either examined at the county level or the state level in the United States. The results of analysis at lower administrative levels would be useful for local policy makers to make informed health policy decisions. OBJECTIVE This study aimed to investigate the ecological association between SDOH factors and population health outcomes at the census tract level and the city level. The findings of this study can be applied to support local policy makers in efforts to improve population health, enhance the quality of care, and reduce health inequity. METHODS This ecological analysis was conducted based on 29,126 census tracts in 499 cities across all 50 states in the United States. These cities were grouped into 5 categories based on their population density and political affiliation. Feature selection was applied to reduce the number of SDOH variables from 148 to 9. A linear mixed-effects model was then applied to account for the fixed effect and random effects of SDOH variables at both the census tract level and the city level. RESULTS The finding reveals that all 9 selected SDOH variables had a statistically significant impact on population health outcomes for ≥2 city groups classified by population density and political affiliation; however, the magnitude of the impact varied among the different groups. The results also show that 4 SDOH risk factors, namely, asthma, kidney disease, smoking, and food stamps, significantly affect population health outcomes in all groups (P<.01 or P<.001). The group differences in health outcomes for the 4 factors were further assessed using a predictive margin analysis. CONCLUSIONS The analysis reveals that population density and political affiliation are effective delineations for separating how the SDOH affects health outcomes. In addition, different SDOH risk factors have varied effects on health outcomes among different city groups but similar effects within city groups. Our study has 2 policy implications. First, cities in different groups should prioritize different resources for SDOH risk mitigation to maximize health outcomes. Second, cities in the same group can share knowledge and enable more effective SDOH-enabled policy transfers for population health.
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Affiliation(s)
- Ace Vo
- Information Systems and Business Analytics Department, Loyola Marymount University, Los Angeles, CA, United States
| | - Youyou Tao
- Information Systems and Business Analytics Department, Loyola Marymount University, Los Angeles, CA, United States
| | - Yan Li
- Center for Information Systems and Technology, Claremont Graduate University, Claremont, CA, United States
| | - Abdulaziz Albarrak
- Information Systems Department, King Faisal University, Al-Ahsa, Saudi Arabia
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12
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Nanda A, Siles R, Park H, Louisias M, Ariue B, Castillo M, Anand MP, Nguyen AP, Jean T, Lopez M, Altisheh R, Pappalardo AA. Ensuring equitable access to guideline-based asthma care across the lifespan: Tips and future directions to the successful implementation of the new NAEPP 2020 guidelines, a Work Group Report of the AAAAI Asthma, Cough, Diagnosis, and Treatment Committee. J Allergy Clin Immunol 2023; 151:869-880. [PMID: 36720288 DOI: 10.1016/j.jaci.2023.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/08/2023] [Accepted: 01/19/2023] [Indexed: 01/29/2023]
Abstract
The most recent recommendations from the 2020 National Asthma Education and Prevention Program Update and Global Initiative for Asthma 2021 guide evidence-based clinical decision making. However, given the present state of health disparities by age, income, and race, the equitable implementation and dissemination of these guidelines will be unlikely without further guidance. This work group report reviews the current state of the new asthma guideline implementation; presents updated evidence-based therapeutic options with attention to specific patient populations; and addresses barriers to the implementation of these guidelines in minoritized, historically marginalized, and underresourced communities. Allergists and immunologists can use practical ways to accomplish the goals of improved asthma care access and advanced asthma care across the life span, with specific considerations to historically marginalized populations. Modifiable barriers to guideline implementation include financial barriers, environmental factors, and allergy subspecialty access and care coordination. Various programs to improve access to guideline-based asthma care include community programs, school-based asthma programs, and digital health solutions, with an emphasis on reducing disparities by race.
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Affiliation(s)
- Anil Nanda
- Asthma and Allergy Center, Lewisville-Flower Mound; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas
| | - Roxana Siles
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland
| | - Henna Park
- Department of Pediatrics, University of Illinois Hospital, Chicago
| | - Margee Louisias
- Department of Medicine, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Cleveland; Department of Immunology, Boston Children's Hospital, Boston; Harvard Medical School, Boston
| | - Barbara Ariue
- Department of Pediatrics, Division of Allergy/Immunology, Loma Linda Children's Hospital, Loma Linda
| | - Maria Castillo
- Department of Medical Education at Driscoll Children's Hospital, Corpus Christi
| | - Mahesh Padukudru Anand
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore
| | - Anh P Nguyen
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, School of Medicine, University of California Davis, Sacramento
| | - Tiffany Jean
- Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange
| | - Michael Lopez
- Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange
| | - Roula Altisheh
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland
| | - Andrea A Pappalardo
- Department of Pediatrics, Department of Medicine, University of Illinois at Chicago, Chicago
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13
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Tyris J, Rodean J, Kulesa J, Dixon G, Bhansali P, Gayle T, Akani D, Magyar M, Tamaskar N, Parikh K. Social Risks and Health Care Utilization Among a National Sample of Children With Asthma. Acad Pediatr 2023; 23:130-139. [PMID: 35940571 DOI: 10.1016/j.acap.2022.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Prior studies using single-center populations have established associations between social risks and health care utilization among children with asthma. We aimed to evaluate associations between social risks and health care utilization among a nationally representative sample of children with asthma. STUDY DESIGN In this cross-sectional study, we utilized the 2018-2019 National Survey of Children's Health to identify children 2 to 17 years old with asthma. Using the Healthy People (HP) 2030 social determinants of health (SDOH) framework, we identified 31 survey items assessing 18 caregiver-identified social risks as exposure variables and classified them into the 5 HP SDOH domains (Economy, Education, Health care, Community, and Environment). Primary outcome was caregiver-reported health care utilization. Associations between individual social risks and total number of SDOH domains experienced with health care utilization were assessed. RESULTS The weighted study population included 8.05 million children, 96% of whom reported ≥1 social risk. Fourteen social risks, spanning all 5 SDOH domains, were significantly associated with increased health care utilization. The 3 risks with the highest adjusted odds ratios (aOR) of health care utilization included: experiencing discrimination (aOR 3.26 [95% confidence interval (CI): 1.75, 6.08]); receiving free/reduced lunch (aOR 2.16, [95% CI 1.57, 2.98]); and being a victim of violence (aOR 2.11, [95% CI 1.11, 4]). Children with risks across more SDOH domains reported significantly higher health care utilization. CONCLUSIONS Among our national population of children with asthma, social risks are prevalent and associated with increased health care utilization, highlighting their potential contribution to pediatric asthma morbidity.
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Affiliation(s)
- Jordan Tyris
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC.
| | | | - John Kulesa
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Gabrina Dixon
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Priti Bhansali
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Tamara Gayle
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Damilola Akani
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Matthew Magyar
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Nisha Tamaskar
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kavita Parikh
- Division of Hospital Medicine (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), Children's National Hospital, Washington, DC; Department of Pediatrics (J Tyris, J Kulesa, G Dixon, P Bhansali, T Gayle, D Akani, M Magyar, N Tamaskar, and K Parikh), George Washington University School of Medicine and Health Sciences, Washington, DC
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Agnihotri NT, Nyenhuis SM. Global Considerations in Asthma Treatment: Management in Low Resource Settings. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:377-394. [PMID: 37464129 DOI: 10.1007/978-3-031-32259-4_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Low-resource settings have a disproportionately higher burden of asthma due to factors that include environmental triggers, access to healthcare, availability of medications, and uncoordinated health systems. The application of guideline-based management can vary, which further impacts the treatment delivered. This chapter aims to outline the global landscape of asthma management, including cultural and social factors, with suggestions for interventions.
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Affiliation(s)
- Neha T Agnihotri
- University of Illinois at Chicago, Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, Chicago, IL, USA
| | - Sharmilee M Nyenhuis
- University of Chicago, Pediatrics, Section of Allergy and Immunology, Chicago, IL, USA.
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15
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Park H, Pappalardo AA. Invited Perspective: Call to Action-Reduce Immigrants' Disparities in Environmental Exposures and Health. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:91301. [PMID: 36053725 PMCID: PMC9438917 DOI: 10.1289/ehp11003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/25/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Henna Park
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andrea A. Pappalardo
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Internal Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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16
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Davis CM, Wang J. Reducing Health Disparities in Allergy Immunology: The Time Is Now. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:979-980. [PMID: 35397817 DOI: 10.1016/j.jaip.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Carla M Davis
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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17
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Perry TT, Patel MR, Li JT. Elevating Health Disparities Education Among Trainees and Physicians. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:918-922. [PMID: 35033699 DOI: 10.1016/j.jaip.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/08/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
Health disparities disproportionately affect patients in racial and ethnic minority groups, and these disparities are linked to economic, environmental, and social disadvantage. It is widely known that health disparities impact patients with allergic and immunologic conditions, yet universal and comprehensive training in health disparities is lacking. More robust educational opportunities are needed to fully equip trainees with tools to recognize and develop effective strategies to reduce the burden of health disparities. Also, there are no universal standards or requirements for professional medical boards in their respective maintenance of certification programs that will ensure ongoing training for practicing providers that will help them identify and manage individual or societal issues such as social determinants that contribute to health disparities. Further, the long-term impact of systematic discrimination, implicit and overt bias, and medical mistrust among populations most often affected by disparities compounds the complexity of the methods and types of training that is desperately needed to overcome health disparities. We provide a commentary on important topics that should be addressed during allergy and immunology training and beyond. We further highlight strategies and tools that should be used to tackle this important issue affecting millions of patients under our specialty care. It is past time for us to go beyond the bedside and comprehensively integrate health disparities training in our fellowship programs and in our practices.
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Affiliation(s)
- Tamara T Perry
- University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, Ark.
| | - Minal R Patel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Mich
| | - James T Li
- Division of Allergy and Immunology, Mayo Clinic, Rochester, Minn
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