Social Vulnerability Is Associated with Poorer Outcomes in Preschool Children With Recurrent Wheezing Despite Standardized and Supervised Medical Care.
Pubmed ID: 35123099
Pubmed Central ID: PMC9007879
Journal: The journal of allergy and clinical immunology. In practice
Publication Date: 04/01/2022
Affiliation: Department of Pediatrics, Emory University, Atlanta, Ga; Division of Pediatric Pulmonology, Children's Healthcare of Atlanta, Atlanta, Ga. Electronic address: firstname.lastname@example.org.
MeSH Terms: Humans, Child, Quality of Life, Asthma, Child, Preschool, Respiratory Sounds, Respiratory Tract Infections, Social Vulnerability
Grants: K24 NR018866, R01 NR017939, UL1 TR002378
Authors: Mutic AD, Mauger DT, Grunwell JR, Opolka C, Fitzpatrick AM
Cite As: Mutic AD, Mauger DT, Grunwell JR, Opolka C, Fitzpatrick AM. Social Vulnerability Is Associated with Poorer Outcomes in Preschool Children With Recurrent Wheezing Despite Standardized and Supervised Medical Care. J Allergy Clin Immunol Pract 2022 Apr;10(4):994-1002. Epub 2022 Feb 2.
- AsthmaNet Azithromycin for Preventing the Development of Upper Respiratory Tract Illness Into Lower Respiratory Tract Symptoms in Children (APRIL) and Oral Corticosteroids for Treating Episodes of Significant Lower Respiratory Tract Symptoms in Children (OCELOT)
- AsthmaNet Individualized Therapy For Asthma in Toddlers (INFANT) and Acetaminophen Versus Ibuprofen in Children With Asthma (AVICA)
BACKGROUND: Social determinants of health are associated with disparate asthma outcomes in school-age children. Social determinants have not been studied in preschool children with recurrent wheezing. OBJECTIVE: We hypothesized that preschool children with recurrent wheezing at highest risk of social vulnerability would have more frequent symptoms and exacerbations when followed over 1 year, despite receiving standardized and supervised asthma care. METHODS: A multicenter population of adherent preschool children receiving standardized and supervised care for wheezing was stratified by a composite measure of social vulnerability based on individual-level variables. Primary outcomes included days with upper respiratory infections and days with asthma symptom flares. Other outcomes included symptom scores during upper respiratory infections and respiratory symptom flare days, exacerbation occurrence, quality of life during the exacerbation, and hospitalization. RESULTS: Preschool children at highest risk of social vulnerability did not have more frequent upper respiratory infections, respiratory symptoms, or exacerbations, but instead had more severe symptoms during upper respiratory infections and respiratory flare days, as well as more severe exacerbations with significantly poorer caregiver quality of life. Children at highest risk of social vulnerability also lived in poorer housing conditions with differing exposures and self-reported triggers. CONCLUSIONS: Individual-level social determinants of health reflecting social vulnerability are associated with poorer outcomes in preschool children with recurrent wheezing despite access to supervised and standardized care. Comprehensive assessment of social determinants of health is warranted in even the youngest children with wheezing, because mitigation of these social inequities is an essential first step toward improving outcomes in pediatric patients.