Medical and Social Determinants of Health Associated with Intensive Care Admission for Asthma in Children

McDowell, Karen M.; Kercsmar, Carolyn M.; Huang, Bin; Guilbert, Theresa W.; Kahn, Robert S.

doi:10.1513/annalsats.201512-798oc

Cited by 23 publications

(32 citation statements)

References 51 publications

(57 reference statements)

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“…Epstein et al found that lower income, Latino race, and children with government insurance were all associated with higher disease severity at the time of admission to the ICU . Some studies have focused on the impact of social determinants on asthma ICU admissions, but with conflicting results . Moghaddas et al found asthmatic patients admitted to the ICU had a lower socioeconomic index when compared to those admitted to the general ward .…”

Section: Discussionmentioning

confidence: 99%

“…Moghaddas et al found asthmatic patients admitted to the ICU had a lower socioeconomic index when compared to those admitted to the general ward . McDowell et al, on the other hand, found intrinsic disease factors, such as allergic sensitization, were more important for ICU admission among asthmatic patients . Other studies have investigated the impact of social determinants on ICU procedures and outcomes .…”

Section: Discussionmentioning

confidence: 99%

“…Various studies have explored the role of social determinants on intensive care unit admissions, disease severity, and patient outcomes. [26][27][28][29] Epstein et al found that lower income, Latino race, and children with government insurance were all associated with higher disease severity at the time of admission to the ICU. 26 Some studies have focused on the impact of social determinants on asthma ICU admissions, but with conflicting results.…”

Section: Discussionmentioning

confidence: 99%

“…26 Some studies have focused on the impact of social determinants on asthma ICU admissions, but with conflicting results. 27,28,30 Moghaddas et al found asthmatic patients admitted to the ICU had a lower socioeconomic index when compared to those admitted to the general ward. 27 McDowell et al, on the other hand, found intrinsic disease factors, such as allergic sensitization, were more important for ICU admission among asthmatic patients.…”

Section: Discussionmentioning

confidence: 99%

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The impact of social determinants of health on laryngotracheal stenosis development and outcomes

et al. 2019

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Objectives The social determinants of health affect a wide range of health outcomes and risks. To date, there have been no studies evaluating the impact of social determinants of health on laryngotracheal stenosis (LTS). We sought to describe the social determinants in a cohort of LTS patients and explore their association with treatment outcome. Methods Subjects diagnosed with LTS undergoing surgical procedures between 2013 and 2018 were identified. Matched controls were identified from intensive care unit (ICU) patients who underwent intubation for greater than 24 hours. Medical comorbidities, stenosis characteristics, and patient demographics were abstracted from the clinical record. Tracheostomy at last follow‐up was recorded from the medical record and phone calls. Socioeconomic data was obtained from the American Community Survey. Results One hundred twenty‐two cases met inclusion criteria. Cases had significantly lower education compared to Tennessee (P = .009) but similar education rates as ICU controls. Cases had significantly higher body mass index (odds ratio [OR]: 1.04, P = .035), duration of intubation (OR: 1.21, P < .001), and tobacco use (OR: 1.21, P = .006) in adjusted analysis when compared to controls. Tracheostomy dependence within the case cohort was significantly associated with public insurance (OR: 1.33, P = .016) and chronic obstructive pulmonary disease (OR: 1.34, P = .018) in adjusted analysis. Conclusion Intubation practices, medical comorbidities and social determinants of health may influence the development of LTS and tracheostomy dependence after treatment. Identification of at‐risk populations in ICUs may allow for prevention of tracheostomy dependence through the use of early tracheostomy and specialized follow‐up. Level of Evidence Level 3, retrospective review comparing cases and controls Laryngoscope, 130:1000–1006, 2020

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The impact of social determinants of health on laryngotracheal stenosis development and outcomes

et al. 2019

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“…28, 29 Although a pooled analysis of birth cohorts found that pet ownership did not modify the risk of asthma onset in children, 30 sensitized children who own pets may be at higher risk for severe asthma exacerbation requiring intensive care. 31 Cat and dog ownership also contributes to higher indoor endotoxin concentrations, which have been associated with wheezing and increased respiratory medication use. 32 Indoor dust mite and mold exposures are other risk factors that have also been linked to exacerbations of asthma in children.…”

Section: Discussionmentioning

confidence: 99%

Predictors of emergency department use in children with persistent asthma in metropolitan Atlanta, Georgia

Franklin

Grunwell

Bruce

et al. 2017

Annals of Allergy, Asthma & Immunology

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Outdoor air pollution and near‐fatal/fatal asthma attacks in children: A systematic review

Varghese,

Ferris,

Lee

et al. 2024

Pediatric Pulmonology

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BackgroundGlobally, observational studies have demonstrated an association between high levels of air pollution and asthma attacks in children. It remains unclear whether and to what extent exposure may be associated with increased near‐fatal/fatal attacks.ObjectiveTo systematically review the evidence for an association between ambient outdoor air pollution and fatal and/or near‐fatal asthma (NFA).MethodsFollowing Cochrane methodology, we searched MEDLINE, EMBASE, Web of Science, Scopus, and Open Grey electronic databases for studies reporting the association of fatal/NFA and air pollution (particulate matter [PM], sulfur dioxide, nitrogen dioxide, black carbon and ozone [O3]) in children. NFA was defined as requiring intensive care unit (ICU) management.ResultsTwo reviewers independently screened 1358 papers. A total of 276 studies identified asthma attacks related to air pollution, 272 did not meet inclusion criteria after full‐text review. Four observational studies described fatal/NFA, of which three addressed NFA. PM2.5 (per 12.5 µg/m3 increase) and O3 (per 22 ppb increase) were associated with NFA in one study (PM2.5, relative risk: 1.26, confidence interval [CI] [1.10–1.44]), O3 (1.19 [1.01–1.40]). PM10 was associated with ICU admission in the context of thunderstorm asthma. Elemental carbon was associated equally with NFA that did not require an ICU admission (p = 0.67). Studies of fatal asthma including children did not demarcate age within the analysis.ConclusionsOzone and PM2.5 have been associated with NFA in children but synthesis is limited by the paucity of studies and methodological heterogeneity. Poor reporting of severities of asthma attacks hinders the assessment of whether outdoor air pollution is associated with an increased number of NFA/fatal attacks in children.

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Medical and Social Determinants of Health Associated with Intensive Care Admission for Asthma in Children

Cited by 23 publications

References 51 publications

The impact of social determinants of health on laryngotracheal stenosis development and outcomes

The impact of social determinants of health on laryngotracheal stenosis development and outcomes

Predictors of emergency department use in children with persistent asthma in metropolitan Atlanta, Georgia

Outdoor air pollution and near‐fatal/fatal asthma attacks in children: A systematic review

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