Asthma Health Equity Index identifies social determinants of health, helps patients connect with services

A program at Rady Children's Hospital-San Diego using an asthma equity dashboard demonstrates that disparities exist among patients in San Diego with moderate to severe asthma who visit the emergency department, and the index has the potential to help other areas identify and assist such populations.

In "Creating a System to Identify Social Determinants of Health and Achieve Equitable Health Outcomes for Children with Asthma," researchers at Rady Children's Health Network developed an Asthma Health Equity Index to redefine how they capture and display equity-related data to address a need for a standardized approach to measure and track health equity-related improvements.

To test the index, the team targeted children living with poorly controlled asthma recently seen in the emergency department and conducted telephone outreach via a patient care coordinator to identify disparities through social determinants of health screenings for food insecurity, housing, transportation, and tobacco use while also ensuring the families had adequate follow-up and asthma education

Race and ethnicity were strongly associated with food insecurity, unstable housing, and tobacco use. Families speaking a language other than English experienced the same challenges, and also experienced transportation challenges. Compared to non-Hispanic White families, patients who identified as Hispanic, non-Hispanic Black and non-Hispanic other were 2 to 4 times more likely to experience unstable housing; Hispanic families were three times more likely to experience food insecurity and transportation issues; non-Hispanic Blacks were two times more likely to experience tobacco use/smoke exposure.

Lastly, when compared to those who speak English, Spanish-speaking patients were 3.3 times more likely to experience food insecurity, and two times more likely to experience unstable housing and transportation issues.

"When managing the health of a child and, in particular, any chronic condition such as asthma, it is critical to acknowledge the profound importance that social determinants, race, ethnicity, and language barriers play in the life of that child and family," said Dr. Keri L. Carstairs, vice president of network operations and clinical integration and the chief population health officer at Rady Children's. "By committing to an understanding of those needs that extend beyond the health care setting, we can have a greater impact on the health of children by designing necessary interventions to support these needs through the development of a collaborative community ecosystem with community partnerships that can support vulnerable populations."

By incorporating social determinants of health screenings into outreach effort and combining this information with demographic data such as race, ethnicity, and zip code details, the authors note, populations and neighborhoods in need of supportive services can more easily be identified and connected with help available in their neighborhoods.