‍Environmental and Social Factors Could Indicate Asthma Severity in Children

Environmental and social factors may serve as indicators of asthma severity in children, suggesting that conditions like air quality, housing conditions, and socioeconomic status could influence the severity of asthma symptoms experienced by pediatric patients, highlighting the complex interplay between environmental and social determinants of health in childhood asthma.

The authors highlight that these discoveries enhance comprehension of asthma risks at the neighborhood level, suggesting that the next phase may entail recognizing and rectifying inequalities.

A recent study suggests that both the environmental and social conditions within neighborhoods can forecast the likelihood of severe asthma in children on a very local scale. This aligns with earlier research indicating that alongside biological predispositions, interactions with diverse social, environmental, and external factors play a role in asthma risk.

In the study, researchers highlight asthma as a prevalent chronic health issue among children, affecting around 1 in 6. Moreover, the severity of the condition varies widely, with some experiencing occasional attacks triggered by factors like physical activity or allergies, while others endure persistent symptoms. Dr. Emily Skeen, a pediatric pulmonologist at Children’s Hospital Colorado and a fellow at the University of Colorado School of Medicine, emphasized that neighborhoods in close proximity to their hospital bear a disproportionate burden of these social determinants. She noted a higher incidence of severe asthma cases among children from these areas, highlighting the unequal impact across the city and the importance of identifying underlying causes.

This research involved collecting data from 193 pediatric asthma patients aged 8 to 17, spanning two observational cohorts. These patients were divided into two groups: exacerbation-prone (EP), comprising 142 children who had experienced one or more exacerbations in the last year, and exacerbation-null, consisting of 51 children who had not experienced exacerbations in the past five years. These participants were recruited from urban areas and various asthma clinics across three locations.

Furthermore, the study gathered spirometry, exhaled nitric oxide, allergen-specific immunoglobulin E (IgE), and Composite Asthma Severity Index (CASI) data. The relationship between Child Opportunity Index 2.0 (COI) and EP status was evaluated using logistic regression. COI encompasses 29 indicators of children's healthy development, such as education, housing safety, access to nutritious food, parks, clean air, and economic opportunities. These indicators are categorized into education, health and environment, and social and economic domains.

“In this paper, we focused on children with EP asthma, a subgroup characterized by severe breathing difficulties, frequent medication use including steroids, and occasional reliance on emergency care or hospitalization for respiratory support,” Skeen explained in the press release. “These children, though constituting a small portion, bear the brunt of asthma's impact in terms of symptoms, school absenteeism, and healthcare costs. Our study delves into the intricate relationships among these factors and their impact on asthma.”

The study revealed that a lower COI correlated with increased likelihood of EP asthma. A decrease of 20 points in COI was associated with roughly 40% higher odds of EP asthma (OR 1.4; 95% CI 1.1–1.76), alongside a corresponding increase in CASI of 0.34. However, COI did not exhibit significant associations with other clinical parameters.

Although this association remained consistent even after accounting for age and sex (OR 1.38, 95% CI 1.1–1.75), its strength diminished when further adjustments were made for race and ethnicity (OR 1.19, 95% CI 0.92–1.54). Notably, while the Social/Economic and Education COI domains displayed similar effects, the Health/Environment domain did not exhibit a significant association.

Furthermore, the researchers noted that the educational, social, and economic indicators within the COI exhibited stronger predictive power for a heightened risk of EP asthma compared to the health and environmental factors, such as air pollution. They hypothesized that this might be attributed to the limited variability in ozone and particulate matter levels across the neighborhoods included in the study.

According to the authors, these findings underscore the potential utility of COI in comprehending neighborhood-level risks and pinpointing community targets to mitigate asthma disparities. "The next phase involves determining actionable steps that can have the most significant impact," Skeen remarked in the press release.

Source: pharmacytimes