TY - JOUR
T1 - Role of social deprivation on asthma care quality among a cohort of children in US community health centres
AU - Lucas, Jennifer A.
AU - Marino, Miguel
AU - Fankhauser, Katie
AU - Bazemore, Andrew
AU - Giebultowicz, Sophia
AU - Cowburn, Stuart
AU - Kaufmann, Jorge
AU - Ezekiel-Herrera, David
AU - Heintzman, John
N1 - Funding Information:
Acknowledgements This research was conducted with Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Research Network (CRN), a member of PCORnet, an initiative originally funded by the Patient-Centered Outcomes Research Institute (PCORI) and now funded by the People-Centered Research Foundation (PCRF). The ADVANCE network is led by OCHIN in partnership with Health Choice Network, Fenway Health, Oregon Health & Science University and the Robert Graham Center/HealthLandscape. ADVANCE is funded through PCRF (contract number 1237).
Funding Information:
Funding This work was supported by an NIH National Institute on Minority Health and Health Disparities grant (R01MD011404; BACKGROUND Study, principal investigator: JH).
Publisher Copyright:
© 2021 BMJ Publishing Group. All rights reserved.
PY - 2021/6/23
Y1 - 2021/6/23
N2 - Objective Social deprivation is associated with worse asthma outcomes. The Social Deprivation Index is a composite measure of social determinants of health used to identify neighbourhood-level disadvantage in healthcare. Our objective was to determine if higher neighbourhood-level social deprivation is associated with documented asthma care quality measures among children treated at community health centres (CHCs). Methods (setting, participants, outcome measures) We used data from CHCs in 15 states in the Accelerating Data Value Across a National Community Health Center Network (ADVANCE). The sample included 34 266 children with asthma from 2008 to 2017, aged 3-17 living in neighbourhoods with differing levels of social deprivation measured using quartiles of the Social Deprivation Index score. We conducted logistic regression to examine the odds of problem list documentation of asthma and asthma severity, and negative binomial regression for rates of albuterol, inhaled steroid and oral steroid prescription adjusted for patient-level covariates. Results Children from the most deprived neighbourhoods had increased rates of albuterol (rate ratio (RR)=1.22, 95% CI 1.13 to 1.32) compared with those in the least deprived neighbourhoods, while the point estimate for inhaled steroids was higher, but fell just short of significance at the alpha=0.05 level (RR=1.16, 95% CI 0.99 to 1.34). We did not observe community-level differences in problem list documentation of asthma or asthma severity. Conclusions Higher neighbourhood-level social deprivation was associated with more albuterol and inhaled steroid prescriptions among children with asthma, while problem list documentation of asthma and asthma severity varied little across neighbourhoods with differing deprivation scores. While the homogeneity of the CHC safety net setting studied may mitigate variation in diagnosis and documentation of asthma, enhanced clinician awareness of differences in community risk could help target paediatric patients at risk of lower quality asthma care.
AB - Objective Social deprivation is associated with worse asthma outcomes. The Social Deprivation Index is a composite measure of social determinants of health used to identify neighbourhood-level disadvantage in healthcare. Our objective was to determine if higher neighbourhood-level social deprivation is associated with documented asthma care quality measures among children treated at community health centres (CHCs). Methods (setting, participants, outcome measures) We used data from CHCs in 15 states in the Accelerating Data Value Across a National Community Health Center Network (ADVANCE). The sample included 34 266 children with asthma from 2008 to 2017, aged 3-17 living in neighbourhoods with differing levels of social deprivation measured using quartiles of the Social Deprivation Index score. We conducted logistic regression to examine the odds of problem list documentation of asthma and asthma severity, and negative binomial regression for rates of albuterol, inhaled steroid and oral steroid prescription adjusted for patient-level covariates. Results Children from the most deprived neighbourhoods had increased rates of albuterol (rate ratio (RR)=1.22, 95% CI 1.13 to 1.32) compared with those in the least deprived neighbourhoods, while the point estimate for inhaled steroids was higher, but fell just short of significance at the alpha=0.05 level (RR=1.16, 95% CI 0.99 to 1.34). We did not observe community-level differences in problem list documentation of asthma or asthma severity. Conclusions Higher neighbourhood-level social deprivation was associated with more albuterol and inhaled steroid prescriptions among children with asthma, while problem list documentation of asthma and asthma severity varied little across neighbourhoods with differing deprivation scores. While the homogeneity of the CHC safety net setting studied may mitigate variation in diagnosis and documentation of asthma, enhanced clinician awareness of differences in community risk could help target paediatric patients at risk of lower quality asthma care.
KW - asthma
KW - community child health
KW - quality in health care
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U2 - 10.1136/bmjopen-2020-045131
DO - 10.1136/bmjopen-2020-045131
M3 - Article
C2 - 34162640
AN - SCOPUS:85108598989
SN - 2044-6055
VL - 11
JO - BMJ Open
JF - BMJ Open
IS - 6
M1 - e045131
ER -