Association of Social Determinants of Health with Pediatric Asthma Hospitalization after Treatment in the Emergency Department

Biomedical and non-biomedical factors influence outcomes for children with asthma exacerbations in emergency department (ED) settings. Modeling these factors may advance our understanding of drivers of health disparities, which will inform interventions to decrease them. Our aim is to quantify the association of Social Determinants of Health (SDoH) with hospitalization of children with acute asthma.This retrospective cross-sectional study examined all children 2-17 years old who visited a Pediatric Emergency Care Applied Research Network (PECARN) Registry site for acute asthma over four years. The primary outcome was hospitalization. Measures of clinical severity were age, sex, triage acuity, vital signs, and asthma history. Patient-level SDoH were race, ethnicity, and primary payer. Neighborhood-level SDoH was assessed by nationally-normed Child Opportunity Index (COI), based on zip code of the subject's address. Analysis included univariable and multivariable LASSO regression models. We compared area under the curve (AUC) between a model that included only clinical severity variables and models that added SDoH variables.We included 65,706 visits from January 2017 to December 2020, of whom 26,160 (39.8%) were hospitalized. The AUC of the severity-only model was 0.798. The maximal AUC of models that included SDoH was 0.800. White non-Hispanic children had higher odds of hospitalization in all models.Addition of patient and neighborhood-level SDoH to a severity-only model did not increase predictive accuracy for hospitalization in children with asthma in a large multicenter cohort. Examination of care delivery and more detailed SDoH will be important to clarify why outcomes differ for children with asthma.