Unmet Social Needs Linked to High-Risk Asthma Severity Status in Children

Children with unmet social needs are at a greater risk of having persistent asthma, with more unmet social needs associated with a greater risk of persistent asthma severity status, according to a study published in Academic Pediatrics.

“Our finding that the strength of the association between unmet social needs and asthma severity status is greater with a greater number of identified unmet social needs provides further insight into the ways unmet needs may be related to health outcomes,” wrote the researchers of this study.

With asthma being the leading cause of chronic disease among children in the United States, disproportionately affecting minoritized populations, the researchers aimed to identify social needs that are specific to pediatric asthma, which may help reduce the burden of asthma disease among children.

A total of 15,148 patients, aged 2 to 21 years, were screened for unmet social needs (housing quality, housing instability, food insecurity, health-related transportation, utility costs, health care costs, need for legal assistance, need for child or adult-care assistance, and domestic dispute or interspinal violence) and asthma severity between April 2018 and December 2019.

Among the patients identified, 6482 patients had a current diagnosis of asthma and had completed a standard asthma severity screening within the same period. Patients were excluded for missing information regarding unmet social needs or asthma severity screening.

This analysis included data from 4887 patients who had been screened for both unmet social needs and asthma severity status at 15 primary care practices in the Bronx, New York.

Overall results show that persistent asthma severity was associated with housing quality (7.3%), lack of money for food (4.9%), and transportation (3.7%). Furthermore, having 3 or more unmet social needs was associated with 59% greater odds of persistent asthma (odds ratio [OR], 1.59; 95% CI, 1.18-2.14; P = .002); having 2 unmet social needs, a 33% greater risk of persistent asthma (OR, 1.33; 95% CI, 1.00-1.78; P = .05); and having 1 unmet social need, a 5% greater risk of persistent asthma (OR, 1.05; 95% CI, 0.86-1.30).

In addition, the children with diagnosed persistent asthma were over a year younger than those with diagnosed intermittent asthma: 11.0 vs 12.2 years.

Although the researchers acknowledged that the cross-sectional nature of the study limited their ability to draw causality or the direction of the association between unmet social needs and asthma severity, they believe this study adds to growing evidence from prior studies on the effects of unmet social needs and worse health outcomes.

“We provide evidence that unmet social needs are an important variable in risk-stratifying an already high-risk 14 group of pediatric asthma patients,” wrote the researchers. “The larger question of how to use these findings to intervene on disparities in asthma outcomes is of urgent and paramount importance.”

Reference

Telzak A, Fiori KP, Chambers EC, Haughton J, Levano S, Reznik M. Unmet social needs and pediatric asthma severity in an urban primary care setting. Academic Pediatrics. Published online February 19, 2023. doi:10.1016/j.acap.2023.02.009