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Khalid M, Almasri T, Goble S, Johnson D, Gilbertson D, Linzer M, Strykowski R. Seasonal Variations and Social Disparities in Asthma Hospitalizations and Outcomes. J Asthma 2024:1-24. [PMID: 39046135 DOI: 10.1080/02770903.2024.2383630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/09/2024] [Accepted: 07/19/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE Exposure to asthma exacerbating triggers may be dependent on the season and an individual's social factors and subsequent means to avoid triggers. We assessed for seasonal variations and differential outcomes based on race and income in admissions for asthma in a United States nationwide assessment. METHODS This retrospective study assessed adult hospitalizations for asthma 2016-2019 using the National Inpatient Sample. Hospitalizations were categorized by season: winter (December-February), spring (March-May), summer (June-August), fall (September-November). Multivariable linear and logistic regression were used to assess associations between season, race, income quartile (determined by the median income within a patient's ZIP code), and outcomes. RESULTS The study included 423,140 admissions with a mean age of 51 years, and 73% of the cohort being female and 56% non-white. Admissions peaked during winter (124, 145) and were lowest in summer (80,525). Intubation rates were increased in summer compared to winter (2.73% vs 1.93%, aOR = 1.19, 95% CI: 1.04-1.37) as were rates of non-invasive positive pressure ventilation (NIPPV) (7.92% vs 7.06%, aOR = 1.08, 95% CI: 1.00-1.17). Compared to white patients, intubation (2.53% vs 1.87%, absolute difference 0.66%, aOR = 1.14, 95% CI: 1.02-1.29) and NIPPV (9.95% vs 5.45%, absolute difference 4.5%, aOR = 1.69, 95% CI: 1.57-1.82) were increased in Black patients. No significant associations between income and clinical outcomes were found. CONCLUSIONS Asthma admission peak during winter, while summer admissions and non-white race are associated with higher rates of NIPPV and intubation. Public health initiatives and strategically timed outpatient visits could combat seasonal variation and social disparities in asthma outcomes.
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Affiliation(s)
- Mohammed Khalid
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Talal Almasri
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Spencer Goble
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | | | - David Gilbertson
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
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Chambliss SE, Matsui EC, Zárate RA, Zigler CM. The Role of Neighborhood Air Pollution in Disparate Racial and Ethnic Asthma Acute Care Use. Am J Respir Crit Care Med 2024; 210:178-185. [PMID: 38412262 PMCID: PMC11273303 DOI: 10.1164/rccm.202307-1185oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/27/2024] [Indexed: 02/29/2024] Open
Abstract
Rationale: The share of Black or Latinx residents in a census tract remains associated with asthma-related emergency department (ED) visit rates after controlling for socioeconomic factors. The extent to which evident disparities relate to the within-city heterogeneity of long-term air pollution exposure remains unclear. Objectives: To investigate the role of intraurban spatial variability of air pollution in asthma acute care use disparity. Methods: An administrative database was used to define census tract population-based incidence rates of asthma-related ED visits. We estimate the associations between census tract incidence rates and 1) average fine and coarse particulate matter, nitrogen dioxide (NO2), and sulfur dioxide (SO2), and 2) racial and ethnic composition using generalized linear models controlling for socioeconomic and housing covariates. We also examine for the attenuation of incidence risk ratios (IRRs) associated with race/ethnicity when controlling for air pollution exposure. Measurements and Main Results: Fine and coarse particulate matter and SO2 are all associated with census tract-level incidence rates of asthma-related ED visits, and multipollutant models show evidence of independent risk associated with coarse particulate matter and SO2. The association between census tract incidence rate and Black resident share (IRR, 1.51 [credible interval (CI), 1.48-1.54]) is attenuated by 24% when accounting for air pollution (IRR, 1.39 [CI, 1.35-1.42]), and the association with Latinx resident share (IRR, 1.11 [CI, 1.09-1.13]) is attenuated by 32% (IRR, 1.08 [CI, 1.06-1.10]). Conclusions: Neighborhood-level rates of asthma acute care use are associated with local air pollution. Controlling for air pollution attenuates associations with census tract racial/ethnic composition, suggesting that intracity variability in air pollution could contribute to neighborhood-to-neighborhood asthma morbidity disparities.
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Affiliation(s)
- Sarah E. Chambliss
- Department of Population Health
- Center for Health and Environment: Education and Research, and
| | - Elizabeth C. Matsui
- Department of Population Health
- Center for Health and Environment: Education and Research, and
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas; and
| | | | - Corwin M. Zigler
- Center for Health and Environment: Education and Research, and
- Department of Statistics and Data Sciences, The University of Texas at Austin, Austin, Texas
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Fitzpatrick AM, Grunwell JR, Gaur H, Kobara S, Kamaleswaran R. Plasma metabolomics identifies differing endotypes of recurrent wheezing in preschool children differentiated by symptoms and social disadvantage. Sci Rep 2024; 14:15813. [PMID: 38982241 PMCID: PMC11233605 DOI: 10.1038/s41598-024-66878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/04/2024] [Indexed: 07/11/2024] Open
Abstract
Preschool children with recurrent wheezing are a heterogeneous population with many underlying biological pathways that contribute to clinical presentations. Although the morbidity of recurrent wheezing in preschool children is significant, biological studies in this population remain quite limited. To address this gap, this study performed untargeted plasma metabolomic analyses in 68 preschool children with recurrent wheezing to identify metabolomic endotypes of wheezing. K-means cluster analysis was performed on metabolomic dataset including a total of 1382 named and unnamed metabolites. We identified three metabolomic clusters which differed in symptom severity, exacerbation occurrence, and variables associated with social disadvantage. Metabolites that distinguished the clusters included those involved in fatty acid metabolism, fatty acids (long chain monounsaturated fatty acids, long chain polyunsaturated fatty acids, and long chain saturated fatty acids), lysophospholipids, phosphatidylcholines, and phosphatidylethanolamines. Pathway analyses identified pathways of interest in each cluster, including steroid metabolism, histidine metabolism, sphingomyelins, and sphingosines, among others. This study highlights the biologic complexity of recurrent wheezing in preschool children and offers novel metabolites and pathways that may be amenable to future study and intervention.
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Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive Office #340, 30322, Atlanta, Georgia.
- Division of Pulmonary Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
| | - Jocelyn R Grunwell
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive Office #340, 30322, Atlanta, Georgia
- Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Hina Gaur
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
| | - Seibi Kobara
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
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Qin X, Pate CA, Zahran HS. Factors associated with emergency department visits for asthma resulting in hospital admission-United States, 2020. J Asthma 2024; 61:717-724. [PMID: 38193801 PMCID: PMC11166518 DOI: 10.1080/02770903.2024.2303753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/07/2024] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To identify risk factors associated with hospital admission following an ED visit for asthma at the time of discharge among U.S. children and adults. METHODS Asthma emergency department visits resulting in hospital admissions using discharge data among children (aged 0-17 years) and adults (aged 18 years or older) from the 2020 Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality were examined. Risk factors associated with hospital admission following ED visits were identified using univariable and multi-variable logistic regression models. RESULTS Among children, hospital admission after asthma-related ED visits was higher for females, ages less than 12 years, and discharged in January-March or in October-December and lower for Black children, Hispanic children, Medicaid or Medicare beneficiaries, other/no charge/self-pay, and in metropolitan non-teaching or non-metropolitan hospitals. Among adults, asthma ED visits resulting in hospital admissions were higher for females, ages 35 years or older, discharged in January-March, and for Medicare beneficiaries and lower for Black adults, Hispanic adults, adults of other races, other/no charge/self-pay, in metropolitan non-teaching or non-metropolitan hospitals, and median household income quartiles for patient's ZIP Code of less than $59,000 were lower. CONCLUSIONS Sociodemographic factors, healthcare use, and household income were significantly associated with hospital admissions at the time of discharge from the ED. Examining hospital admission after an ED visit for asthma is important in identifying these groups and better addressing their healthcare needs.
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Affiliation(s)
- Xiaoting Qin
- Asthma and Air Quality Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cynthia A. Pate
- Asthma and Air Quality Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hatice S. Zahran
- Asthma and Air Quality Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Skeen EH, Moore CM, Federico MJ, Seibold MA, Liu AH, Hamlington KL. The Child Opportunity Index 2.0 and exacerbation-prone asthma in a cohort of urban children. Pediatr Pulmonol 2024; 59:1894-1904. [PMID: 38558492 DOI: 10.1002/ppul.26998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
RATIONALE Social determinants of health underlie disparities in asthma. However, the effects of individual determinants likely interact, so a summary metric may better capture their impact. The Child Opportunity Index 2.0 (COI) is one such tool, yet its association with exacerbation-prone (EP) asthma is unknown. OBJECTIVE To investigate the association between the COI and EP asthma and clinical measures of asthma severity in children. METHODS We analyzed data from two prospective observational pediatric asthma cohorts (n = 193). Children were classified as EP (≥1 exacerbation in the past 12 months) or exacerbation-null (no exacerbations in the past 5 years). Spirometry, exhaled nitric oxide, IgE, and Composite Asthma Severity Index (CASI) were obtained. The association between COI and EP status was assessed with logistic regression. We fit linear and logistic regression models to test the association between COI and each clinical measure. RESULTS A 20-point COI decrease conferred 40% higher odds of EP asthma (OR 1.4; 95%CI 1.1-1.76). The effect was similar when adjusted for age and sex (OR 1.38, 95%CI 1.1-1.75) but was attenuated with additional adjustment for race and ethnicity (OR 1.19, 95%CI 0.92-1.54). A similar effect was seen for the Social/Economic and Education COI domains but not the Health/Environment Domain. A 20-point COI decrease was associated with an increase in CASI of 0.34. COI was not associated with other clinical measures. CONCLUSIONS Lower COI was associated with greater odds of EP asthma. This highlights the potential use of the COI to understand neighborhood-level risk and identify community targets to reduce asthma disparities.
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Affiliation(s)
- Emily H Skeen
- Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Camille M Moore
- Center for Genes, Environment and Health, National Jewish Health, Denver, Colorado, USA
| | - Monica J Federico
- Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Max A Seibold
- Center for Genes, Environment and Health, National Jewish Health, Denver, Colorado, USA
| | - Andrew H Liu
- Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Katharine L Hamlington
- Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Payne AS, Moore K, Casazza A, Parikh K, Cora-Bramble D. Initiative to Increase Equity in Clinical Care: Experience at 1 Children's Hospital. Pediatrics 2024; 153:e2023063096. [PMID: 38747040 DOI: 10.1542/peds.2023-063096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 06/02/2024] Open
Affiliation(s)
- Asha S Payne
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine, Washington, District of Columbia; and
| | - Katharine Moore
- Children's National Hospital, Washington, District of Columbia
| | - Angelina Casazza
- Children's National Hospital, Washington, District of Columbia
- Angelina Casazza Consulting, Kensington, Maryland
| | - Kavita Parikh
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine, Washington, District of Columbia; and
| | - Denice Cora-Bramble
- Children's National Hospital, Washington, District of Columbia
- The George Washington University School of Medicine, Washington, District of Columbia; and
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Gaietto K, Han YY, Rosser FJ, Acosta-Pérez E, Forno E, Canino G, Celedón JC. Socioeconomic status, diet, and recurrent severe asthma exacerbations in Puerto Rican youth. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100220. [PMID: 38375461 PMCID: PMC10875262 DOI: 10.1016/j.jacig.2024.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 02/21/2024]
Abstract
Background Why Puerto Rican youths have higher rates of severe asthma exacerbations (SAEs) than their non-Hispanic White peers is unclear. Objective We aimed to identify risk factors associated with recurrent SAEs in Puerto Rican youths with asthma. Methods We performed cross-sectional and longitudinal analyses of recurrent SAEs in 209 Puerto Rican youths with asthma who participated in 2 cross-sectional studies approximately 5.2 years apart: the Puerto Rico Genetics of Asthma and Lifestyle study (visit 1, participants aged 6-14 years) and the Epigenetic Variation and Childhood Asthma in Puerto Ricans study (visit 2, participants aged 9-20 years). Recurrent SAEs were defined as at least 2 SAEs in the previous year. Results Of the youths in our study, there were 80 (38.3%) and 47 (22.4%) with recurrent SAEs at visit 1 and visit 2, respectively, and 31 participants (14.8%) had persistent recurrent SAEs (ie, recurrent SAEs at both visits). In multivariable analyses, low household income was significantly associated with 2.4 to 12.3 times increased odds of recurrent SAEs in all analyses, with stronger longitudinal associations. Low parental education level, nonprivate or employer-based health insurance, overweight or obesity, residential proximity to a major road, and low or moderate level of outdoor activity were each significantly associated with recurrent SAEs in at least 1 analysis. Further, persistence of low parental numeracy level, low household income, and an unhealthy diet were each associated with persistent recurrent SAEs. Conclusion In this study of Puerto Rican youths with asthma, persistence of low parental numeracy level, a low household income, and an unhealthy diet were associated with persistent recurrent SAEs. Our findings support policies promoting equity and healthy lifestyles for Puerto Rican children and their families.
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Affiliation(s)
- Kristina Gaietto
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Yueh-Ying Han
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Franziska J. Rosser
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Edna Acosta-Pérez
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Juan C. Celedón
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
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Adavadkar PA, Brooks L, Pappalardo AA, Schwartz A, Rasinski K, Martin MA. Association between sleep disorders and health care utilization in children with chronic medical conditions: a Medicaid claims data analysis. J Clin Sleep Med 2024; 20:595-601. [PMID: 38217477 PMCID: PMC10985290 DOI: 10.5664/jcsm.10936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 01/15/2024]
Abstract
STUDY OBJECTIVES To examine the risk of increased health care utilization (HU) linked to individual sleep disorders in children with chronic medical conditions. METHODS Medicaid claims data from a cohort of 16,325 children enrolled in the Coordinated Healthcare for Complex Kids (CHECK) project were used. Sleep disorders and chronic medical conditions were identified using International Classification of Diseases, Ninth, and 10th Revision, codes. Three HU groups were identified based on participants' prior hospitalizations and emergency department (ED) visits in the 12 months prior to enrollment: low (no hospitalization or ED visit), medium (1-2 hospitalizations or 1-3 ED visits), and high (≥ 3 hospitalizations or ≥ 4 ED visits). The odds of being in an increased HU group associated with specific sleep disorders after controlling for confounding factors were examined. RESULTS Children with chronic medical conditions and any sleep disorder had nearly twice the odds (odds ratio = 1.83; 95% confidence interval: 1.67-2.01) of being in an increased HU group compared with those without a sleep disorder. The odds of being in the increased HU group varied among sleep disorders. Only sleep-disordered breathing (odds ratio = 1.51; 95% confidence interval : 1.17-1.95), insomnia (odds ratio = 1.46; 95% confidence interval : 1.06-2.02), and circadian rhythm sleep disorder (odds ratio = 2.45; 95% confidence interval : 1.07-5.64) increased those odds. Younger age and being White were also linked to increased HU. CONCLUSIONS Sleep disorders are associated with increased risk of heightened HU (ED visits and/or hospitalizations) in children with chronic medical conditions. This risk varies by specific sleep disorders. These findings indicate the need for careful evaluation and management of sleep disorders in this high-risk cohort. CITATION Adavadkar PA, Brooks L, Pappalardo AA, Schwartz A, Rasinski K, Martin MA. Association between sleep disorders and health care utilization in children with chronic medical conditions: a Medicaid claims data analysis. J Clin Sleep Med. 2024;20(4):595-601.
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Affiliation(s)
| | - Lee Brooks
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | | | - Alan Schwartz
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Kenneth Rasinski
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Molly A. Martin
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
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Wilson NG, Hernandez-Leyva A, Schwartz DJ, Bacharier LB, Kau AL. The gut metagenome harbors metabolic and antibiotic resistance signatures of moderate-to-severe asthma. FEMS MICROBES 2024; 5:xtae010. [PMID: 38560624 PMCID: PMC10981462 DOI: 10.1093/femsmc/xtae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Asthma is a common allergic airway disease that has been associated with the development of the human microbiome early in life. Both the composition and function of the infant gut microbiota have been linked to asthma risk, but functional alterations in the gut microbiota of older patients with established asthma remain an important knowledge gap. Here, we performed whole metagenomic shotgun sequencing of 95 stool samples from a cross-sectional cohort of 59 healthy and 36 subjects with moderate-to-severe asthma to characterize the metagenomes of gut microbiota in adults and children 6 years and older. Mapping of functional orthologs revealed that asthma contributes to 2.9% of the variation in metagenomic content even when accounting for other important clinical demographics. Differential abundance analysis showed an enrichment of long-chain fatty acid (LCFA) metabolism pathways, which have been previously implicated in airway smooth muscle and immune responses in asthma. We also observed increased richness of antibiotic resistance genes (ARGs) in people with asthma. Several differentially abundant ARGs in the asthma cohort encode resistance to macrolide antibiotics, which are often prescribed to patients with asthma. Lastly, we found that ARG and virulence factor (VF) richness in the microbiome were correlated in both cohorts. ARG and VF pairs co-occurred in both cohorts suggesting that virulence and antibiotic resistance traits are coselected and maintained in the fecal microbiota of people with asthma. Overall, our results show functional alterations via LCFA biosynthetic genes and increases in antibiotic resistance genes in the gut microbiota of subjects with moderate-to-severe asthma and could have implications for asthma management and treatment.
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Affiliation(s)
- Naomi G Wilson
- Division of Allergy and Immunology, Department of Medicine and Center for Women’s Infectious Disease Research, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, United States
| | - Ariel Hernandez-Leyva
- Division of Allergy and Immunology, Department of Medicine and Center for Women’s Infectious Disease Research, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, United States
| | - Drew J Schwartz
- Division of Infectious Diseases, Department of Pediatrics and Center for Women’s Infectious Disease Research, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, United States
| | - Leonard B Bacharier
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN 37232, United States
| | - Andrew L Kau
- Division of Allergy and Immunology, Department of Medicine and Center for Women’s Infectious Disease Research, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, United States
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Jones SM, Anvari S, Coleman A, Pesek RD, Kloepfer KM, Perry TT, Jefferson AA, Doan D, Andres A, Doderer M, Hilbun A, Solomon R, Scurlock AM. Food insecurity and allergic diseases: A call to collective action. J Allergy Clin Immunol 2024; 153:359-367. [PMID: 37926122 DOI: 10.1016/j.jaci.2023.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
Food security encompassess the concept of access by all people at all times to enough food for an active, healthy life. Conversely, food insecurity (FI) refers to household-level economic and social conditions of limited or uncertain access to adequate food. FI is a key social determinant of health that can negatively affect nutrition and health outcomes, as it is estimated that 10.2% of the US population meets criteria for FI. Recognizing the impact of FI on our patients and families is critical to promote health equity and optimize health outcomes. This review focuses on FI and allergic disease from the perspective of key multisector stakeholders within the field of allergy and immunology as well as from the larger health care arena, highlighting key resources and initiatives important to patients. Collectively, as specialists in allergy and immunology, and within the medical field more broadly, we must leverage our unique roles as we interface with patients and families and serve as committed advocates for change. Developing innovative strategies to promote health equity can provide a pathway forward for all children, adults, and families to gain access to healthy, nutritious food as part of their routine lifestyle. This is a call to action.
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Affiliation(s)
- Stacie M Jones
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark.
| | - Sara Anvari
- Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Amaziah Coleman
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Robert D Pesek
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
| | - Kirsten M Kloepfer
- Indiana University School of Medicine and Riley Children's Hospital at IU Health, Indianapolis, Ind
| | - Tamara T Perry
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
| | - Akilah A Jefferson
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
| | - Dieu Doan
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
| | - Aline Andres
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Nutrition Center, Little Rock, Ark
| | - Marcy Doderer
- Arkansas Children's Hospital, Little Rock, Ark; Arkansas Children's Health System, Little Rock, Ark
| | - Ashlie Hilbun
- Arkansas Children's Hospital, Little Rock, Ark; Arkansas Children's Health System, Little Rock, Ark
| | - Ryan Solomon
- Arkansas Children's Hospital, Little Rock, Ark; Arkansas Children's Health System, Little Rock, Ark
| | - Amy M Scurlock
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
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Perry TT, Marko A, Russell AF, Cooke AT, Bingemann TA, Ross KR, Young MC. How Schools Can Help Address Social Determinants of Health in Asthma Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:316-326. [PMID: 37839577 DOI: 10.1016/j.jaip.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
Schools are in a unique position to address social determinants of health (SDOHs) in pediatric asthma management because of their potential to provide resources and facilitate collaboration with health care providers and services for children at risk within their community. SDOHs include economic factors, educational attainment and health literacy, neighborhood factors and the built environment, social and community aspects including discrimination and racism, and health care access and quality. These factors have a significant impact on asthma health in children, and certain populations such as minoritzed populations and those living in high-poverty environments have been shown to be at greater risk for adverse effects of SDOHs on asthma outcomes. School-based asthma programs address several SDOHs including health literacy, the built environment, and health care quality and access and have been shown to improve asthma outcomes. Key components include connection between the school and the health care team, self-management education, and directly observed therapy. School nurses play a key role in directing and managing effective programs because they can evaluate and support a student's health while considering the effect of SDOHs at interpersonal, institutional, community, and policy levels.
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Affiliation(s)
- Tamara T Perry
- Division of Allergy and Immunology, College of Medicine, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Angela Marko
- Division of Pediatric Pulmonology and Sleep Medicine, UH Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio.
| | - Anne F Russell
- School of Nursing and Health Sciences, Spring Arbor University, Spring Arbor, Mich; Food Allergy and Anaphylaxis Michigan Association, Ann Arbor, Mich
| | - Abigail T Cooke
- Allergy and Asthma Specialists, Durango, Colo; Colorado State University-Pueblo: Graduate School of Nursing, Pueblo, Colo
| | - Theresa A Bingemann
- Departments of Allergy, Immunology and Rheumatology and Pediatric Allergy and Immunology, University of Rochester School of Medicine, Rochester, NY
| | - Kristie R Ross
- Division of Pediatric Pulmonology and Sleep Medicine, UH Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Michael C Young
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
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Bergmans RS, Chambers-Peeple K, Yu C, Xiao LZ, Wegryn-Jones R, Martin A, Dell'Imperio S, Aboul-Hassan D, Williams DA, Clauw DJ, DeJonckheere M. 'I'm still here, I'm alive and breathing': The experience of Black Americans with long COVID. J Clin Nurs 2024; 33:162-177. [PMID: 37140186 PMCID: PMC10624641 DOI: 10.1111/jocn.16733] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 12/05/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
AIMS AND OBJECTIVES In this study, we aimed to characterize the impact of long COVID on quality of life and approaches to symptom management among Black American adults. BACKGROUND As a novel condition, qualitative evidence concerning long COVID symptoms and their impact on quality of life can inform the refinement of diagnostic criteria and care plans. However, the underrepresentation of Black Americans in long COVID research is a barrier to achieving equitable care for all long COVID patients. DESIGN We employed an interpretive description study design. METHODS We recruited a convenience sample of 15 Black American adults with long COVID. We analysed the anonymized transcripts from race-concordant, semi-structured interviews using an inductive, thematic analysis approach. We followed the SRQR reporting guidelines. RESULTS We identified four themes: (1) The impact of long COVID symptoms on personal identity and pre-existing conditions; (2) Self-management strategies for long COVID symptoms; (3) Social determinants of health and symptom management; and (4) Effects on interpersonal relationships. CONCLUSION Findings demonstrate the comprehensive ramifications of long COVID on the lives of Black American adults. Results also articulate how pre-existing conditions, social risk factors, distrust due to systemic racism, and the nature of interpersonal relationships can complicate symptom management. RELEVANCE TO CLINICAL PRACTICE Care approaches that support access to and implementation of integrative therapies may be best suited to meet the needs of long COVID patients. Clinicians should also prioritize eliminating patient exposure to discrimination, implicit bias, and microaggressions. This is of particular concern for long COVID patients who have symptoms that are difficult to objectively quantify, such as pain and fatigue. NO PATIENT OR PUBLIC CONTRIBUTION While patient perspectives and experiences were the focus of this study, patients were not involved with the design or conduct of the study, data analysis or interpretation, or writing the manuscript.
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Affiliation(s)
- Rachel S Bergmans
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Christine Yu
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lillian Z Xiao
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Riley Wegryn-Jones
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Allie Martin
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Deena Aboul-Hassan
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
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Owusu-Ansah S, Crowe RP, Ramgopal S. Racial, Ethnic, and Socioeconomic Disparities in Prehospital Encounters for Children with Asthma. PREHOSP EMERG CARE 2023; 27:1107-1114. [PMID: 37748188 DOI: 10.1080/10903127.2023.2260471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE Asthma represents one of the most common medical conditions among children encountered by emergency medical services (EMS). While care disparities for children with asthma have been observed in other healthcare settings, limited data exist characterizing disparities in prehospital care. We sought to characterize differences in prehospital treatment and transport of children with suspected asthma exacerbations by race and ethnicity, within the context of community socioeconomic status. METHODS We conducted a multi-agency retrospective study of EMS encounters in 2019 for children (2-17 years) with asthma and wheezing using a national prehospital database. Our primary outcomes included EMS transport and prehospital bronchodilator or systemic corticosteroid administration. Scene socioeconomic status was evaluated using the social vulnerability index. We used generalized estimating equations to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) for prehospital bronchodilator use or steroid use by race and ethnicity, adjusting for age, presence of abnormal vital signs, community size, bronchodilator use prior to EMS arrival, and transport disposition. RESULTS We analyzed 5,266 EMS encounters (median age 8 years). Approximately half (53%) were Black non-Hispanic and 34% were White non-Hispanic. Overall, 77% were transported by EMS. In an adjusted model, Black non-Hispanic children were 25% less likely to be transported compared to White non-Hispanic children (aOR: 0.75, 95%CI: 0.58-0.96). EMS administered at least one bronchodilator to 81% of Black non-Hispanic patients, 73% of Hispanic patients, and 68% of White, non-Hispanic patients. Relative to White non-Hispanic children, EMS bronchodilator administration was greater for Black non-Hispanic children, (aOR: 1.55, 95%CI: 1.25-1.93), after controlling for scene socioeconomic status and potential confounding variables. Systemic corticosteroids were administered in 3% of all encounters. Odds of prehospital systemic corticosteroid administration did not differ significantly by race and ethnicity. CONCLUSION Black non-Hispanic children comprised a larger proportion of EMS encounters for asthma and were more likely to receive a bronchodilator in adjusted analyses accounting for community socioeconomic status. However, these children were less likely to be transported by EMS. These findings may reflect disease severity not manifested by abnormal vital signs, management, and other social factors that warrant further investigation.
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Affiliation(s)
- Sylvia Owusu-Ansah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Sriram Ramgopal
- Division of Emergency Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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14
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Barber Doucet H, Wilson T, Vrablik L, Wing R. Implicit Bias and Patient Care: Mitigating Bias, Preventing Harm. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11343. [PMID: 37731596 PMCID: PMC10507144 DOI: 10.15766/mep_2374-8265.11343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 06/08/2023] [Indexed: 09/22/2023]
Abstract
Introduction Simulation is a valuable and novel tool in the expanding approach to racism and bias education for medical practitioners. We present a simulation case focused on identifying and addressing the implicit bias of a consultant to teach bias mitigation skills and limit harm to patients and families. Methods Learners were presented with a case of a classic toddler's fracture in an African American child. The learners interacted with an orthopedic resident who insisted on child welfare involvement, with nonspecific and increasingly biased concerns about the child/family. The learners were expected to identify that this case was not concerning for nonaccidental trauma and that the orthopedic resident was demonstrating bias. They were expected to communicate with both the resident and the parent effectively to defuse the situation and prevent harm from reaching the family. A debrief and an anonymous survey followed the case. Results Seventy-five learners participated, including pediatric and emergency medicine residents, fellows, attendings, and medical students. After the case, the majority of learners expressed confidence that they could recognize racial bias in the care of a patient (90%), ensure patient care was not influenced by racial bias (88%), and utilize a tool to frame a concern about bias (79%). Discussion Participants felt that this simulation was relevant and effective and overall left the experience feeling confident in their abilities to identify and manage racially biased patient care. This anti-racist simulation offers an important skill-building opportunity that has been well received by learners.
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Affiliation(s)
- Hannah Barber Doucet
- Assistant Professor, Division of Pediatric Emergency Medicine, Department of Pediatrics, Boston University School of Medicine
| | - Taneisha Wilson
- Assistant Professor, Department of Emergency Medicine, Warren Alpert Medical School of Brown University
| | - Lauren Vrablik
- Third-Year Fellow, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Warren Alpert Medical School of Brown University
| | - Robyn Wing
- Associate Professor, Division of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, Warren Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital, and Director of Pediatric Simulation, Lifespan Medical Simulation Center
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15
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Volerman A, Balachandran U, Zhu M, Akel M, Hull A, Siros M, Luna V, Xu I, Press VG. Evaluating inhaler education interventions for hospitalized children with asthma: A randomized controlled trial. Ann Allergy Asthma Immunol 2023; 131:217-223.e1. [PMID: 36870528 PMCID: PMC10440276 DOI: 10.1016/j.anai.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/09/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Most children with asthma have poor inhaler technique, with detrimental morbidity effects. Guidelines recommend clinicians provide inhaler education at every opportunity, yet resources are limited. A low-cost, technology-based intervention-Virtual Teach-to-Goal (V-TTG)-was developed to deliver tailored inhaler technique education with high fidelity. OBJECTIVE To evaluate whether V-TTG leads to less inhaler misuse among children with asthma who are hospitalized vs brief intervention (BI, reading steps aloud). METHODS A single-center randomized controlled trial of V-TTG vs BI was conducted with 5-to-10-year-old children with asthma hospitalized between January 2019 and February 2020. Inhaler technique was assessed pre- and post-education using 12-step validated checklists (misuse: < 10 steps correct). RESULTS Among 70 children enrolled, mean age was 7.8 years (SD = 1.6). Most (86%) were Black. Most had an emergency department visit (94%) or hospitalization (90%) in the previous year. At baseline, nearly all children misused inhalers (96%). The proportion of children with inhaler misuse decreased significantly in V-TTG (100%→74%, P = .002) and BI (92%→69%, P = .04) groups, with no difference between groups at both time points (P = .2 and .9). On average, children performed 1.5 more steps correctly (SD = 2.0), with greater improvement with V-TTG (mean [SD] = 1.7 [1.6]) vs BI (mean [SD] = 1.4 [2.3]), though not significant (P = .6). Concerning pre and post technique, older children were significantly more likely than younger children to show more correct steps (mean change = 1.9 vs 1.1, P = .002). CONCLUSION A technology-based intervention for tailored inhaler education led to improved technique among children, similarly to reading steps aloud. Older children saw greater benefits. Future studies should evaluate the V-TTG intervention across diverse populations and disease severities to identify the greatest impact. CLINICAL TRIAL REGISTRATION NCT04373499.
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Affiliation(s)
- Anna Volerman
- Department of Medicine, University of Chicago, Chicago, Illinois; Department of Pediatrics, University of Chicago, Chicago, Illinois.
| | - Uma Balachandran
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Mengqi Zhu
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Mary Akel
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Ashley Hull
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Michelle Siros
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Viridiana Luna
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Isabella Xu
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Valerie G Press
- Department of Medicine, University of Chicago, Chicago, Illinois; Department of Pediatrics, University of Chicago, Chicago, Illinois
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16
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Jefferson AA, Brown CC, Eyimina A, Goudie A, Rezaeiahari M, Perry TT, Tilford JM. Asthma Quality Measurement and Adverse Outcomes in Medicaid-Enrolled Children. Pediatrics 2023:e2022059812. [PMID: 37497577 PMCID: PMC10389769 DOI: 10.1542/peds.2022-059812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVES To determine the association between the asthma medication ratio (AMR) quality measure and adverse outcomes among Medicaid-enrolled children with asthma in Arkansas, given concerns regarding the utility of the AMR in evaluating pediatric risk of asthma-related adverse events (AAEs). METHODS We used the Arkansas All-Payer Claims Database to identify Medicaid-enrolled children with asthma using a nonrestrictive case definition and additionally using the standard Healthcare Effectiveness Data and Information Set (HEDIS) persistent asthma definition. We assessed the AMR using the traditional dichotomous HEDIS AMR categorization and across 4 expanded AMR categories. Regression models assessed associations between AMR and AAE including hospitalization and emergency department utilization, with models conducted overall and by race and ethnicity. RESULTS Of the 22 788 children in the analysis, 9.0% had an AAE (6.7% asthma-related emergency department visits; 3.0% asthma-related hospitalizations). We found poor correlation between AMR and AAE, with higher rates of AAE (10.5%) among children with AMR ≥0.5 compared with AMR <0.5 (8.5%; P < .001), and similar patterns stratified by racial and ethnic subgroups. Expanded AMR categorization revealed notable differences in associations between AMR and AAEs, compared with traditional dichotomous categorization, with worse performance in Black children. CONCLUSIONS The AMR performed poorly in identifying risk of adverse outcomes among Medicaid-enrolled children with asthma. These findings underscore concerns of the utility of the AMR in population health management and reliance on restrictive HEDIS definitions. New population health frameworks incorporating broader considerations that accurately identify at-risk children are needed to improve equity in asthma management and outcomes.
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Affiliation(s)
- Akilah A Jefferson
- Department of Pediatrics, Allergy & Immunology Division
- Arkansas Children's Research Institute, Little Rock, Arkansas
| | - Clare C Brown
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and
| | - Arina Eyimina
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and
| | - Anthony Goudie
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and
| | - Mandana Rezaeiahari
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and
| | - Tamara T Perry
- Department of Pediatrics, Allergy & Immunology Division
- Arkansas Children's Research Institute, Little Rock, Arkansas
| | - J Mick Tilford
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and
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Grande M, Eldeirawi KM, Huntington-Moskos L, Polivka B, Nyenhuis SM. The Association of Food Insecurity With Asthma Control in Adults During COVID-19. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2144-2149. [PMID: 37146886 PMCID: PMC10845761 DOI: 10.1016/j.jaip.2023.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/16/2023] [Accepted: 04/10/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Food insecurity has been associated with poorer asthma control in children, but research lacks in adults. OBJECTIVE To assess the frequency of food insecurity and its association with asthma control in adults during the coronavirus disease 2019 pandemic. METHODS An online cross-sectional survey study was conducted in US adults with asthma. Survey questions included how worried or concerned participants were about food security since the pandemic. Asthma control was assessed using the Asthma Control Test, with uncontrolled asthma defined as Asthma Control Test score less than or equal to 19. Self-report of food insecurity since the pandemic was assessed. Food insecurity variables were dichotomized into high insecurity (≥3) or low insecurity (<3). Descriptive statistics and bivariate analyses were performed. RESULTS Of the total participants (N = 866), 82.79% were female; mean age of participants was 44 ± 15.05 years, their mean Asthma Control Test score was 19.25 ± 4.54, and 18.48% had high food insecurity. Participants with high food insecurity were more likely to have uncontrolled asthma (74.38%) compared with those with lower food insecurity (34.99%; P < .01). The relationship between asthma control and food insecurity remained significant after adjusting for age, education, sex, race, anxiety, and living stability concerns due to the pandemic. CONCLUSIONS Food insecurity exists in adults with asthma and is associated with uncontrolled asthma. Providers should consider screening their patients for food insecurity when treating individuals with uncontrolled asthma.
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Affiliation(s)
- Matthew Grande
- College of Medicine, University of Illinois, Chicago, Ill
| | - Kamal M Eldeirawi
- Department of Population Health Nursing Science, University of Illinois, Chicago, Ill
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18
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Akin-Imran A, Bajpai A, McCartan D, Heaney LG, Kee F, Redmond C, Busby J. Ethnic variation in asthma healthcare utilisation and exacerbation: systematic review and meta-analysis. ERJ Open Res 2023; 9:00591-2022. [PMID: 37143831 PMCID: PMC10152257 DOI: 10.1183/23120541.00591-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/10/2023] [Indexed: 05/06/2023] Open
Abstract
Background Patients from ethnic minority groups (EMGs) frequently report poorer asthma outcomes; however, a broad synthesis summarising ethnic disparities is yet to be undertaken. What is the magnitude of ethnic disparities in asthma healthcare utilisation, exacerbations and mortality? Methods MEDLINE, Embase and Web of Science databases were searched for studies reporting ethnic variation in asthma healthcare outcomes (primary care attendance, exacerbation, emergency department (ED) visits, hospitalisation, hospital readmission, ventilation/intubation and mortality) between White patients and those from EMGs. Estimates were displayed using forest plots and random-effects models were used to calculate pooled estimates. We conducted subgroup analyses to explore heterogeneity, including by specific ethnicity (Black, Hispanic, Asian and other). Results 65 studies, comprising 699 882 patients, were included. Most studies (92.3%) were conducted in the United States of America (USA). Patients from EMGs had evidence suggestive of lower levels of primary care attendance (OR 0.72, 95% CI 0.48-1.09), but substantially higher ED visits (OR 1.74, 95% CI 1.53-1.98), hospitalisations (OR 1.63, 95% CI 1.48-1.79) and ventilation/intubation (OR 2.67, 95% CI 1.65-4.31) when compared to White patients. In addition, we found evidence suggestive of increased hospital readmissions (OR 1.19, 95% CI 0.90-1.57) and exacerbation rates (OR 1.10, 95% CI 0.94-1.28) among EMGs. No eligible studies explored disparities in mortality. ED visits were much higher among Black and Hispanic patients, while Asian and other ethnicities had similar rates to White patients. Conclusions EMGs had higher secondary care utilisation and exacerbations. Despite the global importance of this issue, the majority of studies were performed in the USA. Further research into the causes of these disparities, including whether these vary by specific ethnicity, is required to aid the design of effective interventions.
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Affiliation(s)
- AbdulQadr Akin-Imran
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Achint Bajpai
- University of Central Lancashire, University of Central Lancashire Faculty of Clinical and Biomedical Sciences, Preston, UK
| | - Dáire McCartan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Liam G. Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Charlene Redmond
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
- Corresponding author: John Busby ()
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Fitzpatrick AM, Diani B, Kavalieratos D, Corace EA, Mason C, Van Dresser M, Grunwell JR. Poorer Caregiver Mental and Social Health Is Associated With Worse Respiratory Outcomes in Preschool Children With Recurrent Wheezing. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1814-1822. [PMID: 36868472 PMCID: PMC10258161 DOI: 10.1016/j.jaip.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Mental and social health in caregivers of preschool children has been inadequately studied, but it may influence respiratory symptom recognition and management. OBJECTIVE To identify preschool caregivers at highest risk for poor mental and social health outcomes on the basis of patient-reported outcome measures. METHODS Female caregivers 18 to 50 years old (N = 129) with a preschool child aged 12 to 59 months with recurrent wheezing and at least 1 exacerbation in the previous year completed 8 validated patient-reported outcome measures of mental and social health. k-means cluster analysis was performed using the T score for each instrument. Caregiver/child dyads were followed for 6 months. Primary outcomes included caregiver quality of life and wheezing episodes in their preschool children. RESULTS Three clusters of caregivers were identified: low risk (n = 38), moderate risk (n = 56), and high risk (n = 35). The high-risk cluster had the lowest life satisfaction, meaning and purpose, and emotional support and the highest social isolation, depression, anger, perceived stress, and anxiety that persisted for more than 6 months. This cluster had the poorest quality of life and marked disparities in social determinants of health. Preschool children from caregivers in the high-risk cluster had more frequent respiratory symptoms and a higher occurrence of any wheezing episode, but a lower outpatient physician utilization for wheezing management. CONCLUSIONS Caregiver mental and social health is associated with respiratory outcomes in preschool children. Routine assessment of mental and social health in caregivers is warranted to promote health equity and improve wheezing outcomes in preschool children.
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Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga.
| | - Badiallo Diani
- Department of Biomedical Engineering, Emory University, Atlanta, Ga; Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga
| | - Dio Kavalieratos
- Department of Family and Preventative Medicine, Emory University, Atlanta, Ga
| | | | | | | | - Jocelyn R Grunwell
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga
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Krings JG, Gerald JK, Blake KV, Krishnan JA, Reddel HK, Bacharier LB, Dixon AE, Sumino K, Gerald LB, Brownson RC, Persell SD, Clemens CJ, Hiller KM, Castro M, Martinez FD. A Call for the United States to Accelerate the Implementation of Reliever Combination Inhaled Corticosteroid-Formoterol Inhalers in Asthma. Am J Respir Crit Care Med 2023; 207:390-405. [PMID: 36538711 PMCID: PMC9940146 DOI: 10.1164/rccm.202209-1729pp] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- James G. Krings
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Joe K. Gerald
- Department of Community Environment and Policy, Mel and Enid Zuckerman College of Public Health
- Asthma & Airway Disease Research Center, University of Arizona, Tucson, Arizona
| | - Kathryn V. Blake
- Center for Pharmacogenomics and Translational Research, Nemours Children’s Health, Jacksonville, Florida
| | | | - Helen K. Reddel
- The Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia
| | - Leonard B. Bacharier
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anne E. Dixon
- Division of Pulmonary Critical Care, Department of Medicine, University of Vermont, Burlington, Vermont
| | - Kaharu Sumino
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Lynn B. Gerald
- Population Health Sciences Program, University of Illinois Chicago, Chicago, Illinois
| | - Ross C. Brownson
- Department of Surgery, School of Medicine, and
- Prevention Research Center, Brown School, Washington University in Saint Louis, St. Louis, Missouri
| | - Stephen D. Persell
- Division of General Internal Medicine, Department of Medicine, and
- Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Katherine M. Hiller
- Department of Emergency Medicine, School of Medicine, Indiana University, Bloomington, Indiana; and
| | - Mario Castro
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of Kansas, Kansas City, Kansas
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21
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Darby A, Cleveland Manchanda EC, Janeway H, Samra S, Hicks MN, Long R, Gipson KA, Chary AN, Adjei BA, Khanna K, Pierce A, Kaltiso SAO, Spadafore S, Tsai J, Dekker A, Thiessen ME, Foster J, Diaz R, Mizuno M, Schoenfeld E. Race, racism, and antiracism in emergency medicine: A scoping review of the literature and research agenda for the future. Acad Emerg Med 2022; 29:1383-1398. [PMID: 36200540 DOI: 10.1111/acem.14601] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The objective was to conduct a scoping review of the literature and develop consensus-derived research priorities for future research inquiry in an effort to (1) identify and summarize existing research related to race, racism, and antiracism in emergency medicine (EM) and adjacent fields and (2) set the agenda for EM research in these topic areas. METHODS A scoping review of the literature using PubMed and EMBASE databases, as well as review of citations from included articles, formed the basis for discussions with community stakeholders, who in turn helped to inform and shape the discussion and recommendations of participants in the Society for Academic Emergency Medicine (SAEM) consensus conference. Through electronic surveys and two virtual meetings held in April 2021, consensus was reached on terminology, language, and priority research questions, which were rated on importance or impact (highest, medium, lower) and feasibility or ease of answering (easiest, moderate, difficult). RESULTS A total of 344 articles were identified through the literature search, of which 187 met inclusion criteria; an additional 34 were identified through citation review. Findings of racial inequities in EM and related fields were grouped in 28 topic areas, from which emerged 44 key research questions. A dearth of evidence for interventions to address manifestations of racism in EM was noted throughout. CONCLUSIONS Evidence of racism in EM emerged in nearly every facet of our literature. Key research priorities identified through consensus processes provide a roadmap for addressing and eliminating racism and other systems of oppression in EM.
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Affiliation(s)
- Anna Darby
- Department of Emergency Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles, California, USA
| | | | - Hannah Janeway
- Department of EM, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Shamsher Samra
- Department of EM, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Marquita Norman Hicks
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ruby Long
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katrina A Gipson
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anita N Chary
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Brenda A Adjei
- National Cancer Institute Division of Cancer Control and Population Sciences, Bethesda, Maryland, USA
| | - Kajal Khanna
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ava Pierce
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sheri-Ann O Kaltiso
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sophia Spadafore
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer Tsai
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Annette Dekker
- Department of EM, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Molly E Thiessen
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Jordan Foster
- Department of Emergency Medicine, Columbia University Medical Center, New York, New York, USA
| | - Rose Diaz
- Department of EM, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Mikaela Mizuno
- University of California, Riverside School of Medicine, Riverside, California, USA
| | - Elizabeth Schoenfeld
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
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22
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Schuyler AJ, Wenzel SE. Historical Redlining Impacts Contemporary Environmental and Asthma-related Outcomes in Black Adults. Am J Respir Crit Care Med 2022; 206:824-837. [PMID: 35612914 PMCID: PMC9799280 DOI: 10.1164/rccm.202112-2707oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/25/2022] [Indexed: 01/02/2023] Open
Abstract
Rationale: Environmental threats and poorly controlled asthma disproportionately burden Black people. Some have attributed this to socioeconomic or biologic factors; however, racism, specifically historical redlining, a U.S. discriminatory mortgage lending practice in existence between the 1930s and the 1970s, may have actuated and then perpetuated poor asthma-related outcomes. Objectives: To link historical redlining (institutional racism) to contemporary environmental quality- and lung health-related racial inequity. Methods: Leveraging a broadly recruited asthma registry, we geocoded 1,034 registry participants from Pittsburgh/Allegheny County, Pennsylvania, to neighborhoods subjected to historical redlining, as defined by a 1930s Home Owners' Loan Corporation (HOLC) map. Individual-level clinical/physiologic data, residential air pollution, demographics, and socioeconomic factors provided detailed characterization. We determined the prevalence of uncontrolled and/or severe asthma and other asthma-related outcomes by HOLC (neighborhood) grade (A-D). We performed a stratified analysis by self-identified race to assess the distribution of environmental and asthma risk within each HOLC grade. Measurements and Main Results: The registry sampling overall reflected Allegheny County neighborhood populations. The emissions of carbon monoxide, filterable particulate matter <2.5 μm, sulfur dioxide, and volatile organic compounds increased across HOLC grades (all P ⩽ 0.004), with grade D neighborhoods encumbered by the highest levels. The persistent, dispersive socioenvironmental burden peripherally extending from grade D neighborhoods, including racialized access to healthy environments (structural racism), supported a long-term impact of historical/HOLC redlining. The worst asthma-related outcomes, including uncontrolled and/or severe asthma (P < 0.001; Z = 3.81), and evidence for delivery of suboptimal asthma care occurred among registry participants from grade D neighborhoods. Furthermore, elevated exposure to filterable particulate matter <2.5 μm, sulfur dioxide, and volatile organic compound emissions (all P < 0.050) and risk of uncontrolled and/or severe asthma (relative risk [95% confidence interval], 2.30 [1.19, 4.43]; P = 0.009) demonstrated inequitable distributions within grade D neighborhood boundaries, disproportionately burdening Black registry participants. Conclusions: The racist practice of historical/HOLC redlining profoundly contributes to long-term environmental and asthma-related inequities in Black adults. Acknowledging the role racism has in these outcomes should empower more specific and novel interventions targeted at reversing these structural issues.
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Affiliation(s)
- Alexander J. Schuyler
- University of Pittsburgh Asthma and Environmental Lung Health Institute@UPMC and
- Department of Environmental & Occupational Health, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sally E. Wenzel
- University of Pittsburgh Asthma and Environmental Lung Health Institute@UPMC and
- Department of Environmental & Occupational Health, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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23
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Abstract
Clinical decision-making in allergic rhinoconjunctivitis management involves a significant degree of complexity given the number of pharmaceutical agents; the option for allergen immunotherapy (AIT); and the risk for disease advancement, including the development of asthma as well as new environmental allergic sensitivities. Given the complex array of treatment options that are currently available, there is an opportunity to use a shared decision-making (SDM) approach with associated aids and tools that facilitate the interactive participation of practitioners and patients in the SDM process. This article reviews the general constructs of SDM, the unmet need for SDM aids, the collection of patient preference data for allergic rhinoconjunctivitis, the utility of SDM aids which have been specifically created for AIT, and outlines actionable steps to implement AIT SDM in clinical practice.
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24
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Molina MF, Okoniewski W, Puranik S, Aujla S, Celedón JC, Larkin A, Forno E. Severe asthma in children: Description of a large multidisciplinary clinical cohort. Pediatr Pulmonol 2022; 57:1447-1455. [PMID: 35261210 PMCID: PMC9119906 DOI: 10.1002/ppul.25887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 01/08/2022] [Accepted: 02/21/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Children with severe asthma have substantial morbidity and healthcare utilization. Pediatric severe asthma is a heterogeneous disease, and a multidisciplinary approach can improve the diagnosis and management of these children. METHODS We reviewed the electronic health records for patients seen in the Severe Asthma Clinic (SAC) at UPMC Children's Hospital of Pittsburgh between August 2012 and October 2019. RESULTS Of the 110 patients in whom we extracted data, 46% were female, 48% were Black/African American, and 41% had ≥1 admission to the pediatric intensive care unit (PICU) for asthma. Compared to patients without a PICU admission, those with ≥1 PICU admission were more likely to be non-White (64.4% vs. 41.5%, p = 0.031) and more atopic (eosinophil count geometric mean = 673 vs. 319 cells/mm3 , p = 0.002; total IgE geometric mean = 754 vs. 303 KU/L, p = 0.003), and to have lower pre-bronchodilator FEV1 (58.6% [±18.1%] vs. 69.9% [±18.7%], p = 0.002) and elevated FeNO (60% vs. 22%, p = 0.02). In this cohort, 84% of patients were prescribed high-dose ICS/LABA and 36% were on biologics. Following enrollment in the SAC, severe exacerbations decreased from 3.2/year to 2.2/year (p < 0.0001); compared to the year before joining the SAC, in the following year the group had 106 fewer severe exacerbations. CONCLUSIONS This large cohort of children with severe asthma had a high level of morbidity and healthcare utilization. Patients with a history of PICU admissions for asthma were more likely to be nonwhite and highly atopic, and to have lower lung function. Our data support a positive impact of a multidisciplinary clinic on patients with severe childhood asthma.
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Affiliation(s)
- Maria Forero Molina
- Division of Allergy and Immunology and UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
- Division of Pulmonary Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - William Okoniewski
- Division of Pulmonary Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sandeep Puranik
- Division of Pediatric Pulmonology, Indiana University School of Medicine, Indianapolis, IN
| | - Shean Aujla
- Division of Pediatric Pulmonology, Medical University of South Carolina, Charleston, SC
| | - Juan C. Celedón
- Division of Pulmonary Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
- University of Pittsburgh School of Medicine, Pittsburgh, PA
- Pediatric Asthma Center, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Allyson Larkin
- Division of Allergy and Immunology and UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
- Division of Pulmonary Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
- Pediatric Asthma Center, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Erick Forno
- Division of Pulmonary Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
- University of Pittsburgh School of Medicine, Pittsburgh, PA
- Pediatric Asthma Center, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
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25
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Jones CJ, Paudyal P, West RM, Mansur AH, Jay N, Makwana N, Baker S, Krishna MT. Burden of allergic disease among ethnic minority groups in high-income countries. Clin Exp Allergy 2022; 52:604-615. [PMID: 35306712 PMCID: PMC9324921 DOI: 10.1111/cea.14131] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/19/2022]
Abstract
The COVID‐19 pandemic raised acute awareness regarding inequities and inequalities and poor clinical outcomes amongst ethnic minority groups. Studies carried out in North America, the UK and Australia have shown a relatively high burden of asthma and allergies amongst ethnic minority groups. The precise reasons underpinning the high disease burden are not well understood, but it is likely that this involves complex gene–environment interaction, behavioural and cultural elements. Poor clinical outcomes have been related to multiple factors including access to health care, engagement with healthcare professionals and concordance with advice which are affected by deprivation, literacy, cultural norms and health beliefs. It is unclear at present if allergic conditions are intrinsically more severe amongst patients from ethnic minority groups. Most evidence shaping our understanding of disease pathogenesis and clinical management is biased towards data generated from white population resident in high‐income countries. In conjunction with standards of care, it is prudent that a multi‐pronged approach towards provision of composite, culturally tailored, supportive interventions targeting demographic variables at the individual level is needed, but this requires further research and validation. In this narrative review, we provide an overview of epidemiology, sensitization patterns, poor clinical outcomes and possible factors underpinning these observations and highlight priority areas for research.
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Affiliation(s)
- Christina J Jones
- School of Psychology, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Priyamvada Paudyal
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, Brighton, UK
| | - Robert M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Adel H Mansur
- Birmingham Regional Severe Asthma Service, University Hospitals Birmingham NHS Foundation Trust, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Nicola Jay
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Nick Makwana
- Department of Child Health, Sandwell and West Birmingham Hospitals, Birmingham, UK
| | | | - Mamidipudi T Krishna
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Mutic AD, Mauger DT, Grunwell JR, Opolka C, Fitzpatrick AM. Social Vulnerability Is Associated with Poorer Outcomes in Preschool Children With Recurrent Wheezing Despite Standardized and Supervised Medical Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:994-1002. [PMID: 35123099 PMCID: PMC9007879 DOI: 10.1016/j.jaip.2021.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/13/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Social determinants of health are associated with disparate asthma outcomes in school-age children. Social determinants have not been studied in preschool children with recurrent wheezing. OBJECTIVE We hypothesized that preschool children with recurrent wheezing at highest risk of social vulnerability would have more frequent symptoms and exacerbations when followed over 1 year, despite receiving standardized and supervised asthma care. METHODS A multicenter population of adherent preschool children receiving standardized and supervised care for wheezing was stratified by a composite measure of social vulnerability based on individual-level variables. Primary outcomes included days with upper respiratory infections and days with asthma symptom flares. Other outcomes included symptom scores during upper respiratory infections and respiratory symptom flare days, exacerbation occurrence, quality of life during the exacerbation, and hospitalization. RESULTS Preschool children at highest risk of social vulnerability did not have more frequent upper respiratory infections, respiratory symptoms, or exacerbations, but instead had more severe symptoms during upper respiratory infections and respiratory flare days, as well as more severe exacerbations with significantly poorer caregiver quality of life. Children at highest risk of social vulnerability also lived in poorer housing conditions with differing exposures and self-reported triggers. CONCLUSIONS Individual-level social determinants of health reflecting social vulnerability are associated with poorer outcomes in preschool children with recurrent wheezing despite access to supervised and standardized care. Comprehensive assessment of social determinants of health is warranted in even the youngest children with wheezing, because mitigation of these social inequities is an essential first step toward improving outcomes in pediatric patients.
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Affiliation(s)
- Abby D Mutic
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Ga
| | - David T Mauger
- Division of Biostatistics and Bioinformatics, Pennsylvania State University, Hershey, Pa
| | - Jocelyn R Grunwell
- Department of Pediatrics, Emory University, Atlanta, Ga; Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Cydney Opolka
- Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Division of Pediatric Pulmonology, Children's Healthcare of Atlanta, Atlanta, Ga.
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Confirming racial/ethnic disparities in the management of severe bronchiolitis. Am J Emerg Med 2022; 58:333-335. [PMID: 35370036 DOI: 10.1016/j.ajem.2022.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 11/22/2022] Open
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28
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Kaufmann J, Marino M, Lucas J, Bailey SR, Giebultowicz S, Puro J, Ezekiel-Herrera D, Suglia SF, Heintzman J. Racial and Ethnic Disparities in Acute Care Use for Pediatric Asthma. Ann Fam Med 2022; 20:116-122. [PMID: 35346926 PMCID: PMC8959738 DOI: 10.1370/afm.2771] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/30/2021] [Accepted: 08/16/2021] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Previous work has shown that asthma-related emergency department (ED) use is greatest among Black and Latine populations, but it is unknown whether health care use for exacerbations differs across settings (outpatient, ED, inpatient) and correlates with use of routine outpatient services. We aimed to measure disparities by race, ethnicity, and language in pediatric acute asthma care using data from US primary care community health centers. METHODS In an observational study using electronic health records from community health centers in 18 states, we compared non-Hispanic Black, English-preferring Latine, Spanish-preferring Latine, and non-Hispanic White children aged 3 to 17 years on visits for clinic-coded asthma exacerbations (2012-2018). We further evaluated asthma-related ED use and inpatient admissions in a subsample of Oregon-Medicaid recipients. Covariate-adjusted odds ratios (ORs) and rate ratios (RRs) were derived using logistic or negative binomial regression analysis with generalized estimating equations. RESULTS Among 41,276 children with asthma, Spanish-preferring Latine children had higher odds of clinic visits for asthma exacerbation than non-Hispanic White peers (OR = 1.10; 95% CI, 1.02-1.18). Among the subsample of 6,555 children insured under Oregon-Medicaid, non-Hispanic Black children had higher odds and rates of asthma-related ED use than non-Hispanic White peers (OR = 1.40; 95% CI, 1.04-1.89 and RR = 1.49; 95% CI, 1.09-2.04, respectively). We observed no differences between groups in asthma-related inpatient admissions. CONCLUSIONS This study is the first to show that patterns of clinic and ED acute-care use differ for non-Hispanic Black and Spanish-preferring Latine children when compared with non-Hispanic White peers. Non-Hispanic Black children had lower use of clinics, whereas Spanish-preferring Latine children had higher use, including for acute exacerbations. These patterns of clinic use were accompanied by higher ED use among Black children. Ensuring adequate care in clinics may be important in mitigating disparities in asthma outcomes.VISUAL ABSTRACT.
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Affiliation(s)
- Jorge Kaufmann
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.,Biostatistics Group, School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
| | - Jennifer Lucas
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | | | | | | | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.,OCHIN, Portland, Oregon
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29
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Hurbain P, Liu Y, Strickland MJ, Li D. A cross-sectional analysis of associations between environmental indices and asthma in U.S. counties from 2003 to 2012. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:320-332. [PMID: 33895778 PMCID: PMC8542056 DOI: 10.1038/s41370-021-00326-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/20/2021] [Accepted: 03/30/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND To capture the impacts of environmental stressors, environmental indices like the Air Quality Index, Toxic Release Inventory, and Environmental Quality Index have been used to investigate the environmental quality and its association with public health issues. However, past studies often rely on relatively small sample sizes, and they have typically not adjusted for important individual-level disease risk factors. OBJECTIVE We aim to estimate associations between existing environmental indices and asthma prevalence over a large population and multiple years. METHODS Based on data availability, we assessed the predictive capability of these indices for prevalent asthma across U.S. counties from 2003 to 2012. We gathered asthma data from the U.S. CDC Behavioral Risk Factor Surveillance System by county and used multivariable weighted logistic regression models to estimate the associations between the environmental indices and asthma, adjusting for individual factors such as smoking, income level, and obesity. RESULTS Environmental indices showed little to no correlation with one another and with prevalent asthma over time. Associations of environmental indices with prevalent asthma were very weak; whereas individual factors were more substantially associated with prevalent asthma. SIGNIFICANCE Our study suggests that an improved environmental index is needed to predict population-level asthma prevalence.
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Affiliation(s)
- Patrick Hurbain
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | - Yan Liu
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | | | - Dingsheng Li
- School of Community Health Sciences, University of Nevada, Reno, NV, USA.
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30
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Bakshi A, Van Doren A, Maser C, Aubin K, Stewart C, Soileau S, Friedman K, Williams A. Identifying Louisiana communities at the crossroads of environmental and social vulnerability, COVID-19, and asthma. PLoS One 2022; 17:e0264336. [PMID: 35196332 PMCID: PMC8865632 DOI: 10.1371/journal.pone.0264336] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 02/08/2022] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has disproportionately affected the socially and environmentally vulnerable, including through indirect effects on other health conditions. Asthma is one such condition, which may be exacerbated by both prolonged adverse in-home exposures if quarantining in unhealthy homes and prolonged outdoor exposures if the ambient air quality is unhealthy or hazardous. As both are often the case in Environmental Justice (EJ) communities, here we have analyzed data at the census tract (CT) level for Louisiana to assess any correlation between social and environmental vulnerability, and health issues like COVID-19 and asthma. Higher Social Vulnerability Index (SVI), Particulate Matter less than 2.5 μm in diameter (PM2.5) and Ozone levels were associated with higher rates of cumulative COVID-19 incidence at various time points during the pandemic, as well as higher average annual asthma hospitalization rates and estimated asthma prevalence. Further, cumulative COVID-19 incidence during the first three months of the pandemic was moderately correlated with both asthma hospitalizations and estimated prevalence, suggesting similar underlying factors may be affecting both conditions. Additionally, 137 CTs were identified where social and environmental vulnerabilities co-existed, of which 75 (55%) had high estimated prevalence of asthma. These areas are likely to benefit from asthma outreach that considers both social and environmental risk factors. Fifteen out of the 137 CTs (11%) not only had higher estimated prevalence of asthma but also a high burden of COVID-19. Further research in these areas may help to elucidate any common social determinants of health that underlie both asthma and COVID-19 burdens, as well as better clarify the possible role of the environment as related to the COVID-19 burden in Louisiana.
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Affiliation(s)
- Arundhati Bakshi
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Alicia Van Doren
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Colette Maser
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Kathleen Aubin
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Collette Stewart
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Shannon Soileau
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Kate Friedman
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
| | - Alexis Williams
- Section of Environmental Epidemiology and Toxicology, Office of Public Health, Louisiana Department of Health, Baton Rouge, Louisiana, United States of America
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Lugogo N, Judson E, Haight E, Trudo F, Chipps BE, Trevor J, Ambrose CS. Severe asthma exacerbation rates are increased among female, Black, Hispanic, and younger adult patients: results from the US CHRONICLE study. J Asthma 2022; 59:2495-2508. [PMID: 35000529 DOI: 10.1080/02770903.2021.2018701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe clinical outcomes in patients with severe asthma (SA) by common sociodemographic determinants of health: sex, race, ethnicity, and age. METHODS CHRONICLE is an observational study of subspecialist-treated, United States adults with SA receiving biologic therapy, maintenance systemic corticosteroids, or uncontrolled by high-dosage inhaled corticosteroids with additional controllers. For patients enrolled between February 2018 and February 2020, clinical characteristics and asthma outcomes were assessed by sex, race, ethnicity, age at enrollment, and age at diagnosis. Treating subspecialists reported exacerbations, exacerbation-related emergency department visits, and asthma hospitalizations from 12 months before enrollment through the latest data collection. Patients completed the St. George's Respiratory Questionnaire and the Asthma Control Test at enrollment. RESULTS Among 1884 enrolled patients, the majority were female (69%), reported White race (75%), non-Hispanic ethnicity (69%), and were diagnosed with asthma as adults (60%). Female, Black, Hispanic, and younger patients experienced higher annualized rates of exacerbations that were statistically significant compared with male, White, non-Hispanic, and older patients, respectively. Black, Hispanic, and younger patients also experienced higher rates of asthma hospitalizations. Female and Black patients exhibited poorer symptom control and poorer health-related quality of life. CONCLUSIONS In this contemporary, real-world cohort of subspecialist-treated adults with SA, female sex, Black race, Hispanic ethnicity, and younger age were important determinants of health, potentially attributable to physiologic and social factors. Knowledge of these disparities in SA disease burden among subspecialist-treated patients may help optimize care for all patients. Supplemental data for this article is available online at at www.tandfonline.com/ijas .
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Affiliation(s)
| | | | | | | | - Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, CA, USA
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Geospatial Analysis of Social Determinants of Health Identifies Neighborhood Hot Spots Associated with Pediatric Intensive Care Use for Life-threatening Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:981-991.e1. [PMID: 34775118 DOI: 10.1016/j.jaip.2021.10.065] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Social determinants of health are associated with asthma prevalence and healthcare use in children with asthma, but are multifactorial and complex. Whether social determinants similarly influence exacerbation severity is not clear. OBJECTIVE Composite measures of social determinants of health and readmission outcomes were evaluated in a large regional cohort of 1,403 school-age children admitted to a pediatric intensive care unit (PICU) for asthma. METHODS Residential addresses were geocoded and spatially joined to census tracts. Composite measures of social vulnerability and childhood opportunity, PICU readmission rates, and hospital length of stay were compared between neighborhood hot spots, where PICU admission rates per 1,000 children are at or above the 90th percentile, versus non-hot spots. RESULTS A total of 228 children resided within a neighborhood hot spot (16%). Hot spots were associated with a higher (ie, poorer) composite Social Vulnerability Index ranking, reflecting differences in socioeconomic status, household composition and disability, and housing type and transportation. Hot spots also had a lower (ie, poorer) composite Childhood Opportunity Index percentile ranking, reflecting differences in the education, health and environment, and social and economic domains. Higher social vulnerability and lower childhood opportunity were associated with PICU readmission. Residing within a hot spot was further associated with a longer duration of hospital stay, individual inpatient bed days, and total census tract inpatient bed days. CONCLUSIONS Social determinants of health identified by geospatial analyses are associated with more severe asthma exacerbation outcomes in children. Outpatient strategies that address both biological and social determinants of health are needed to care for and prevent PICU admissions optimally in children with asthma.
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Parikh K, Hall M, Kaiser SV, Hogan AH, Bettenhausen JL, Lopez MA, Sills MR. Development of a Health Disparities Index: Proof of Concept with Chest Radiography in Asthma. J Pediatr 2021; 238:290-295.e1. [PMID: 34284032 DOI: 10.1016/j.jpeds.2021.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To develop a tool for quantifying health disparity (Health Disparity Index[HDI]) and explore hospital variation measured by this index using chest radiography (CXR) in asthma as the proof of concept. STUDY DESIGN This was a retrospective cohort study using the Pediatric Health Information System database including children with asthma between 5 and 18 years old. Inpatient and emergency department (ED) encounters from January 1, 2017, to December 31, 2018, with low or moderate severity were included. Exclusions included hospitals with <10 cases in any racial/ethnic group. The HDI measured variation in CXR use among children with asthma based on race/ethnicity. The HDI was calculated as the absolute difference between maximum and minimum percentages of CXR use (range = 0-100) when there was statistical evidence that the percentages were different. RESULTS Data from 36 hospitals included 16 744 inpatient and 75 805 ED encounters. Overall, 19.7% of encounters had a CXR (34.3% for inpatient; 16.5% for ED). In inpatient encounters, 47.2% (17/36) of hospitals had a significant difference in imaging across racial/ethnic groups. Of these, the median hospital-level HDI was 19.4% (IQR 13.5-20.1). In ED encounters, 78.8% (28/36) of hospitals had a statistically significant difference in imaging across racial/ethnic groups, with a median hospital-level HDI of 10.2% (IQR 8.3-14.1). There was no significant association between the inpatient HDI and ED HDI (P = .46). CONCLUSIONS The HDI provides a practical measure of disparity. To improve equity in healthcare, metrics are needed that are intuitive, accurate, usable, and actionable. Next steps include application of this index to other conditions.
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Affiliation(s)
- Kavita Parikh
- Division of Hospital Medicine, Children's National Hospital and George Washington University School of Medicine, Washington, DC.
| | - Matt Hall
- Children's Hospital Association, Lenexa, KS
| | - Sunitha V Kaiser
- Department of Pediatrics, University of California, San Francisco, CA; Department of Clinical Epidemiology and Biostatistics, University of California, San Francisco, CA; Philip R. Lee Institute for Health Policy Studies, San Francisco, CA
| | - Alexander H Hogan
- Division of Hospital Medicine, Connecticut Children's Medical Center, Hartford, CT; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
| | - Jessica L Bettenhausen
- Division of Hospital Medicine, Department of Pediatrics, Children's Mercy, Kansas City, MO; University of Missouri, Kansas City, Kansas City, MO
| | - Michelle A Lopez
- Section of Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX; Center for Child Health Policy and Advocacy, Baylor College of Medicine, Houston, TX
| | - Marion R Sills
- Section of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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Hossain R, Zhao F, Michenkova M, Kaelber D, Tarabichi Y. Trends in racial disparities of emergency department utilization for asthma in coronavirus disease 2019. Ann Allergy Asthma Immunol 2021; 128:95-97. [PMID: 34653604 PMCID: PMC8506577 DOI: 10.1016/j.anai.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Rubayet Hossain
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Department of Emergency Medicine, The MetroHealth System, Cleveland, Ohio; Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio.
| | - Fang Zhao
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio; Department of Pathology, The MetroHealth System, Cleveland, Ohio
| | - Marie Michenkova
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - David Kaelber
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio; Department of Internal Medicine, The MetroHealth System, Cleveland, Ohio; Department of Pediatrics, The MetroHealth System, Cleveland, Ohio
| | - Yasir Tarabichi
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio; Department of Internal Medicine, The MetroHealth System, Cleveland, Ohio; Division of Pulmonary and Critical Care Medicine, The MetroHealth System, Cleveland, Ohio
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Busby J, Heaney LG, Brown T, Chaudhuri R, Dennison P, Gore R, Jackson DJ, Mansur AH, Menzies-Gow A, Message S, Niven R, Patel M, Price D, Siddiqui S, Stone R, Pfeffer PE. Ethnic Differences in Severe Asthma Clinical Care and Outcomes: An Analysis of United Kingdom Primary and Specialist Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:495-505.e2. [PMID: 34626858 DOI: 10.1016/j.jaip.2021.09.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/31/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Understanding the effects of ethnicity in severe asthma is important for optimal personalized patient care. OBJECTIVE To assess ethnic differences in disease control, exacerbations, biological phenotype, and treatment in severe asthma in the United Kingdom. METHODS We compared demographics, type 2 biomarkers, lung function, asthma control, medications, and health care use between White and underrepresented ethnic group patients in the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD). RESULTS A total of 3637 patients (665 from the underrepresented ethnic group) were included from UKSAR and 10,549 (577 from the underrepresented ethnic group) from OPCRD. Patients in the underrepresented ethnic group had higher levels of uncontrolled disease when measurements were made using the asthma control questionnaire in UKSAR (odds ratio [OR] = 1.47; 95% confidence interval [CI], 1.12-1.93) and the Royal College of Physicians 3 Questions in OPCRD (OR = 1.82; 95% CI, 1.27-2.60). Although exacerbation rates were similar, patients in the underrepresented ethnic group were more likely to have recently attended the emergency department (OR = 1.55; 95% CI, 1.26-1.92) or to have been hospitalized (OR = 1.31; 95% CI, 1.07-1.59) owing to asthma. Inflammatory biomarkers were consistently higher in the underrepresented ethnic group, including blood eosinophils in OPCRD (ratio = 1.12; 95% CI, 1.05-1.20) and in UKSAR blood eosinophils (ratio = 1.16; 95% CI, 1.06-1.27), FeNO (ratio = 1.14; 95% CI, 1.04-1.26), and IgE (ratio = 1.70; 95% CI, 1.47-1.97). Patients in the underrepresented ethnic group were more likely to be atopic in the UKSAR (OR = 1.32; 95% CI, 1.07-1.63) and OPCRD (OR = 1.67; 95% CI, 1.26-2.21), and less likely to be using maintenance oral corticosteroids at referral (OR = 0.75; 95% CI, 0.61-0.92). CONCLUSIONS Severe asthma patients from underrepresented ethnic groups presented with a higher disease burden and were more likely to attend the emergency department. They had a distinct phenotypic presentation and differences in medicine use, with higher levels of type 2 biomarkers.
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Affiliation(s)
- John Busby
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University, Belfast, United Kingdom.
| | - Liam G Heaney
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University, Belfast, United Kingdom; Belfast Health and Social Care NHS Trust, Belfast, United Kingdom
| | - Thomas Brown
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | | | - Paddy Dennison
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Robin Gore
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals, London, United Kingdom; Asthma UK Centre, King's College London, London, United Kingdom
| | - Adel H Mansur
- University of Birmingham and Heartlands Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | | | - Simon Message
- Gloucester Royal Hospital, Gloucester, United Kingdom
| | - Rob Niven
- Wythenshawe Hospital, Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Mitesh Patel
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - David Price
- Observational and Pragmatic Research Institute, Singapore; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Salman Siddiqui
- NIHR Leicester Biomedical Research Centre and College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Robert Stone
- Somerset NHS Foundation Trust, Musgrove Park Hospital, Taunton, Somerset, United Kingdom
| | - Paul E Pfeffer
- Barts Health NHS Trust, London, United Kingdom; Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Hester G, Nickel AJ, Watson D, Bergmann KR. Factors Associated With Bronchiolitis Guideline Nonadherence at US Children's Hospitals. Hosp Pediatr 2021; 11:1102-1112. [PMID: 34493589 DOI: 10.1542/hpeds.2020-005785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The objective with this study was to explore factors associated with nonadherence to national bronchiolitis guidelines at 52 children's hospitals. METHODS We included patients 1 month to 2 years old with emergency department (ED) or admission encounters between January 2016 and December 2018 and bronchiolitis diagnoses in the Pediatric Health Information System database. We excluded patients with any intensive care, stay >7 days, encounters in the preceding 30 days, chronic medical conditions, croup, pneumonia, or asthma. Guideline nonadherence was defined as receiving any of 5 tests or treatments: bronchodilators, chest radiographs, systemic steroids, antibiotics, and viral testing. Nonadherence outcomes were modeled by using mixed effects logistic regression with random effects for providers and hospitals. Adjusted odds ratio (aOR) >1 indicates greater likelihood of nonadherence. RESULTS A total of 198 028 encounters were included (141 442 ED and 56 586 admission), and nonadherence was 46.1% (ED: 40.2%, admissions: 61.0%). Nonadherence increased with patient age, with both ED and hospital providers being more likely to order tests and treatments for children 12 to 24 months compared with infants 1 ot 2 months (ED: aOR, 3.39; 95% confidence interval [CI], 3.20-3.60; admissions: aOR, 2.97; CI, 2.79-3.17]). Admitted non-Hispanic Black patients were more likely than non-Hispanic white patients to receive guideline nonadherent care (aOR, 1.16; CI, 1.10-1.23), a difference driven by higher use of steroids (aOR, 1.29; CI, 1.17-1.41) and bronchodilators (aOR, 1.39; CI, 1.31-1.48). Hospital effects were prominent for viral testing in ED and admission encounters (intraclass correlation coefficient of 0.35 and 0.32, respectively). CONCLUSIONS Multiple factors are associated with national bronchiolitis guideline nonadherence.
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Affiliation(s)
| | | | | | - Kelly R Bergmann
- Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota
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Barber Doucet H, Ward VL, Johnson TJ, Lee LK. Implicit Bias and Caring for Diverse Populations: Pediatric Trainee Attitudes and Gaps in Training. Clin Pediatr (Phila) 2021; 60:408-417. [PMID: 34308661 DOI: 10.1177/00099228211035225] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to determine the attitudes, skill level, and preferred educational interventions of pediatric residents related to implicit bias and caring for diverse patient populations. A cross-sectional survey of pediatric residents at a single, large urban residency program was utilized. Surveys were completed by 88 (55%) residents who were 69% female and 35% non-White or mixed race. Almost all residents felt that it was very or extremely important to receive training on health disparities, diverse patient populations, and implicit bias. Self-assessment of skill level revealed that residents felt confident in areas often covered by cultural competency curricula, such as interpreter use, but were less confident in other areas. The top 3 areas identified for further training included implicit bias, working with transgender and gender nonconforming patients, and weight bias. For the majority of diversity and bias-related skills, prior training was significantly correlated with higher skill level (P < .05).
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Affiliation(s)
| | | | | | - Lois K Lee
- Boston Children's Hospital, Boston, MA, USA
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Ross MK, Romero T, Szilagyi PG. Adverse Childhood Experiences and Association With Pediatric Asthma Severity in the 2016-2017 National Survey of Children's Health. Acad Pediatr 2021; 21:1025-1030. [PMID: 33940207 PMCID: PMC8947844 DOI: 10.1016/j.acap.2021.04.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Prior studies have found that adverse childhood experiences (ACEs) are associated with asthma prevalence and onset, presumably related to stress and increased inflammation. We hypothesized that ACEs may be associated with asthma severity as well. We studied the 2016-2017 US National Survey of Children's Health dataset to explore the relationship between ACEs and pediatric asthma severity. METHODS We analyzed children ages 0 to 17 years old who had current caregiver-reported asthma diagnosed by a healthcare provider. We reported descriptive characteristics using chi-square analysis of variance (ANOVA) and used multivariable regression analysis to assess the relationship of cumulative and individual ACEs with asthma severity. Survey sampling weights and SAS survey procedures were implemented to produce nationally representative results. RESULTS Our analysis included 3691 children, representing a population of 5,465,926. Unadjusted analysis demonstrated that ACEs - particularly household economic hardship, parent/guardian served time in jail, witnessed household violence, or victim/witness of neighborhood violence - were each associated with higher odds of moderate/severe caregiver-reported asthma. After controlling for confounders possibly associated with both exposure (ACEs) and outcome (asthma severity), children who witnessed parent/adult violence had higher adjusted odds of caregiver-reported moderate/severe asthma. (1.67, confidence interval 1.05-2.64, P = .03) CONCLUSIONS: Intrafamilial witnessed household violence is significantly associated with caregiver-reported moderate/severe asthma.
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Affiliation(s)
- Mindy K. Ross
- University of California Los Angeles, Department of Pediatrics, Pediatric Pulmonology and Sleep Medicine, Los Angeles, Calif
| | - Tahmineh Romero
- University of California Los Angeles, Department of Medicine, Statistical Core, Los Angeles, Calif
| | - Peter G Szilagyi
- University of California Los Angeles, Department of Pediatrics, General Pediatrics, Los Angeles, Calif
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Prevention and Outpatient Treatment of Asthma Exacerbations in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2567-2576. [PMID: 34246433 DOI: 10.1016/j.jaip.2021.03.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 12/17/2022]
Abstract
Acute exacerbations cause significant morbidity and mortality in children with asthma worldwide. Although exacerbations can be minor and transient, in some children they are recurrent and significantly adversely impact quality of life. Children with frequent exacerbations account for a disproportionate amount of unscheduled care in nonprimary health facilities. Frequent exacerbators are often prescribed controller medications, but poor adherence is common. Major predictors for asthma exacerbations include genetic, social, comorbid, biological, and environmental factors. Although virus infections are a key trigger for exacerbations, other environmental factors also significantly increase risk. A previous exacerbation is a major risk factor for future exacerbations and thus identifies children to target for prevention of future episodes. In this review, we discuss both modifiable and fixed factors associated with asthma exacerbations, how to assess children for risk, and which pharmacological and nonpharmacological interventions may be of benefit. Finally, we review the current evidence around treatment within the outpatient setting for an emerging exacerbation.
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Peer K, Adams WG, Legler A, Sandel M, Levy JI, Boynton-Jarrett R, Kim C, Leibler JH, Fabian MP. Developing and evaluating a pediatric asthma severity computable phenotype derived from electronic health records. J Allergy Clin Immunol 2021; 147:2162-2170. [PMID: 33338540 PMCID: PMC8328264 DOI: 10.1016/j.jaci.2020.11.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Extensive data available in electronic health records (EHRs) have the potential to improve asthma care and understanding of factors influencing asthma outcomes. However, this work can be accomplished only when the EHR data allow for accurate measures of severity, which at present are complex and inconsistent. OBJECTIVE Our aims were to create and evaluate a standardized pediatric asthma severity phenotype based in clinical asthma guidelines for use in EHR-based health initiatives and studies and also to examine the presence and absence of these data in relation to patient characteristics. METHODS We developed an asthma severity computable phenotype and compared the concordance of different severity components contributing to the phenotype to trends in the literature. We used multivariable logistic regression to assess the presence of EHR data relevant to asthma severity. RESULTS The asthma severity computable phenotype performs as expected in comparison with national statistics and the literature. Severity classification for a child is maximized when based on the long-term medication regimen component and minimized when based only on the symptom data component. Use of the severity phenotype results in better, clinically grounded classification. Children for whom severity could be ascertained from these EHR data were more likely to be seen for asthma in the outpatient setting and less likely to be older or Hispanic. Black children were less likely to have lung function testing data present. CONCLUSION We developed a pragmatic computable phenotype for pediatric asthma severity that is transportable to other EHRs.
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Affiliation(s)
- Komal Peer
- Department of Environmental Health, Boston University School of Public Health, Boston, Mass.
| | - William G Adams
- Boston Medical Center, Boston, Mass; Department of Pediatrics, Boston University School of Medicine, Boston, Mass
| | | | - Megan Sandel
- Boston Medical Center, Boston, Mass; Department of Pediatrics, Boston University School of Medicine, Boston, Mass
| | - Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, Mass
| | - Renée Boynton-Jarrett
- Boston Medical Center, Boston, Mass; Department of Pediatrics, Boston University School of Medicine, Boston, Mass
| | - Chanmin Kim
- Department of Statistics, SungKyunKwan University, Seoul, Korea
| | - Jessica H Leibler
- Department of Environmental Health, Boston University School of Public Health, Boston, Mass
| | - M Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, Mass
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Rao DR, Kopp B, Kamerman-Kretzmer RJ, Afolabi F, Liptzin DR, Balasubramaniam V, Sadreameli SC. Advocacy Considerations for the Pediatric Pulmonologist in the Era of the COVID-19 Pandemic. Ann Am Thorac Soc 2021; 18:942-945. [PMID: 33544048 PMCID: PMC8456734 DOI: 10.1513/annalsats.202008-1022ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/04/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Devika R. Rao
- Division of Respiratory Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin Kopp
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Rory John Kamerman-Kretzmer
- Division of Pediatric Pulmonology, Department of Pediatrics, University of California, Davis, Sacramento, California
| | - Folashade Afolabi
- Division of Respiratory Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Deborah R. Liptzin
- Section of Pulmonary Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Vivek Balasubramaniam
- Division of Pediatric Pulmonology and Sleep Medicine, University of Wisconsin–Madison, Madison, Wisconsin; and
| | - S. Christy Sadreameli
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland
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Federico MJ, Denlinger LC, Corren J, Szefler SJ, Fuhlbrigge AL. Exacerbation-Prone Asthma: A Biological Phenotype or a Social Construct. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2627-2634. [PMID: 34051392 DOI: 10.1016/j.jaip.2021.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022]
Abstract
Asthma is a complex syndrome with multiple phenotypes and endotypes. Asthma exacerbations are not only the clearest indictor of the morbidity of asthma and of the risk for mortality due to asthma, but also comprise a significant amount of the cost to care for poorly controlled asthma. There continues to be significant disparity in the prevalence, mortality, and morbidity due to asthma. Patients with asthma who suffer recurrent exacerbations are considered to have exacerbation-prone asthma (EPA). Efforts to characterize patients with frequent exacerbations show that the etiology is likely multifactorial. Research to determine the intrinsic risk factors for EPA include studies of both genetic and inflammatory biomarkers. External factors contributing to exacerbations have been extensively reviewed and include viral infection, environmental exposures, air pollution, and psychosocial and economic barriers to optimizing health. It is likely that EPA occurs when patients who have an increased underlying intrinsic/biological risk are placed in a given exposome (environments with a variety of exposures and triggers including allergens, pollution, stress, barriers, and occupational exposures). It is the social construct combined with underlying biology that frequently drives an EPA phenotype.
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Affiliation(s)
- Monica J Federico
- The Breathing Institute, Children's Hospital Colorado, and Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo.
| | - Loren C Denlinger
- Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Jonathan Corren
- Departments of Medicine and Pediatrics, Divisions of Allergy and Clinical Immunology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, Calif
| | - Stanley J Szefler
- The Breathing Institute, Children's Hospital Colorado, and Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Anne L Fuhlbrigge
- Pulmonary Sciences and Critical Care, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
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Wangberg H, Namazy J. Predicting Who Will Stop Medications During Pregnancy: A Complex Issue. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:1253-1254. [PMID: 33685608 DOI: 10.1016/j.jaip.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Hannah Wangberg
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif.
| | - Jennifer Namazy
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
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Sorensen A, Conway DS, Briggs FBS. Characterizing relapsing remitting multiple sclerosis patients burdened with hypertension, hyperlipidemia, and asthma. Mult Scler Relat Disord 2021; 53:103040. [PMID: 34058603 DOI: 10.1016/j.msard.2021.103040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/09/2021] [Accepted: 05/16/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Hypertension, hyperlipidemia, and asthma are common in multiple sclerosis (MS) patients and adversely impact physical and mental health independent of sociodemographic and clinical attributes. Characterizing MS patients with these comorbidities is necessary for informing comorbidity screening and managed care in vulnerable patient subgroups; however, there is sparse data currently available. METHODS We conducted cross-sectional analyses of 2,012 relapsing remitting (RR) MS patients. Separate multivariable logistic regression models were conducted for the presence of hypertension, hyperlipidemia, and asthma. Independent variables included age, sex, race, MS duration, body mass index classification, insurance payer, smoking status, median income by residence ZIP code, disease modifying therapies, and the other comorbidities. RESULTS Hypertension was more common in RRMS patients who were older, obese/severely obese, had hyperlipidemia, were asthmatics, living in neighborhoods with the lowest income, and who were Black Americans. RRMS patients with hyperlipidemia were more likely to be male, older, overweight/obese/severely obese, hypertensive, asthmatics, and White American. Asthmatic RRMS patients were more likely to be female, obese, hypertensive, and living in neighborhood of medium/low income, and less likely to be on interferons or glatiramer acetate. CONCLUSION We identified factors independently associated with common comorbidity burden in RRMS patients, which will inform risk-stratification efforts aimed at mitigating the adverse impact of these conditions in MS patients. Our results are consistent with what is known about the determinants of hypertension, hyperlipidemia, and asthma in the non-MS patient population, and therefore disparities that exist in screening and management in the general U.S. population may likely exist in U.S. MS patients. It is also possible that there may be unique differences in specific MS patient subgroups, which warrants further investigation and detailed characterization.
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Affiliation(s)
- Alena Sorensen
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Devon S Conway
- The Mellen Center for Multiple Sclerosis and Research, Department of Neurology, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Farren B S Briggs
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Calhoun WJ, Villasante-Tezanos A. Response to Parenteral Triamcinolone in Severe Asthma: A Useful Induced Phenotype for Clinicians? Am J Respir Crit Care Med 2021; 203:790-791. [PMID: 33449842 PMCID: PMC8017573 DOI: 10.1164/rccm.202012-4485ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- William J Calhoun
- Department of Internal Medicine University of Texas Medical Branch Galveston, Texas and
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Abstract
PURPOSE OF REVIEW Pediatric obese asthma is a complex disease that remains poorly understood. The increasing worldwide incidence of both asthma and obesity over the last few decades, their current high prevalence and the challenges in treating obese asthmatic patients all highlight the importance of a better understanding of the pathophysiological mechanisms in obese asthma. While it is well established that patients with obesity are at an increased risk of developing asthma, the mechanisms by which obesity drives the onset of asthma, and modifies existing asthma, remain unclear. Here, we will focus on mechanisms by which obesity alters immune function in asthma. RECENT FINDINGS Lung parenchyma has an altered structure in some pediatric obese asthmatics, known as dysanapsis. Central adiposity is linked to reduced pulmonary function and a better predictor of asthma risk in children than BMI. Obesity in young children is associated with an increased risk of developing asthma, as well as early puberty, and hormonal alterations are implicated in obese asthma. Obesity and asthma each yield immunometabolic dysregulation separately and we are learning more about alterations in these pathways in pediatric obese asthma and the potential impact of bariatric surgery on those processes. SUMMARY The recent progress in clarifying the connections between childhood obesity and asthma and their combined impacts on immune function moves us closer to the goals of improved understanding of the pathophysiological mechanisms underpinning obese asthma and improved therapeutic target selection. However, this common inflammatory disease remains understudied, especially in children, and much remains to be learned.
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Affiliation(s)
- Ceire Hay
- Children’s Hospital of Philadelphia, Department of Pediatrics, Division of Allergy Immunology, Philadelphia, PA
| | - Sarah E. Henrickson
- Children’s Hospital of Philadelphia, Department of Pediatrics, Division of Allergy Immunology, Philadelphia, PA
- Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Davis CM, Apter AJ, Casillas A, Foggs MB, Louisias M, Morris EC, Nanda A, Nelson MR, Ogbogu PU, Walker-McGill CL, Wang J, Perry TT. Health disparities in allergic and immunologic conditions in racial and ethnic underserved populations: A Work Group Report of the AAAAI Committee on the Underserved. J Allergy Clin Immunol 2021; 147:1579-1593. [PMID: 33713767 DOI: 10.1016/j.jaci.2021.02.034] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/13/2021] [Accepted: 02/18/2021] [Indexed: 12/18/2022]
Abstract
Health disparities are health differences linked with economic, social, and environmental disadvantage. They adversely affect groups that have systematically experienced greater social or economic obstacles to health. Renewed efforts are needed to reduced health disparities in the United States, highlighted by the disparate impact on racial minorities during the coronavirus pandemic. Institutional or systemic patterns of racism are promoted and legitimated through accepted societal standards, and organizational processes within the field of medicine, and contribute to health disparities. Herein, we review current evidence regarding health disparities in allergic rhinitis, asthma, atopic dermatitis, food allergy, drug allergy, and primary immune deficiency disease in racial and ethnic underserved populations. Best practices to address these disparities involve addressing social determinants of health and adopting policies to improve access to specialty care and treatment for the underserved through telemedicine and community partnerships, cross-cultural provider training to reduce implicit bias, inclusion of underserved patients in research, implementation of culturally competent patient education, and recruitment and training of health care providers from underserved communities. Addressing health disparities requires a multilevel approach involving patients, health providers, local agencies, professional societies, and national governmental agencies.
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Affiliation(s)
- Carla M Davis
- Baylor College of Medicine, Houston, Tex; Texas Children's Hospital Food Allergy Program, Texas Children's Hospital, Houston, Tex.
| | - Andrea J Apter
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pa
| | - Adrian Casillas
- Texas Tech Health Sciences Center, Sierra Providence Medical Partners, El Paso, Tex
| | - Michael B Foggs
- Advocate Medical Group, Advocate Aurora Health Clinic, Chicago, Ill
| | - Margee Louisias
- Boston Children's Hospital, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass
| | | | - Anil Nanda
- Asthma and Allergy Center, Lewisville, Tex; Asthma and Allergy Center, Flower Mound, Tex; University of Texas Southwestern Medical Center, Dallas, Tex
| | - Michael R Nelson
- Allergy-Immunology Service, Walter Reed National Military Medical Center, Bethesda, Md
| | - Princess U Ogbogu
- Case Western Reserve University-Rainbow Babies and Children/UH Cleveland Medical Center, Cleveland, Ohio
| | - Cheryl Lynn Walker-McGill
- Carolina Complete Health, Charlotte, NC; Wingate University Graduate School of Business, Charlotte, NC
| | - Julie Wang
- Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Tamara T Perry
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark
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Brigham E, Allbright K, Harris D. Health Disparities in Environmental and Occupational Lung Disease. Clin Chest Med 2021; 41:623-639. [PMID: 33153683 DOI: 10.1016/j.ccm.2020.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pulmonary health disparities disproportionately impact disadvantaged and vulnerable populations. This article focuses on disparities in disease prevalence, morbidity, and mortality for asthma, chronic obstructive pulmonary disease, pneumoconiosis, and lung cancer. Disparities are categorized by race, age, sex, socioeconomic status, and geographic region. Each category highlights differences in risk factors for the development and severity of lung disease. Risk factors include social, behavioral, economic, and biologic determinants of health (occupational/environmental exposures, psychosocial stressors, smoking, health literacy, health care provider bias, and health care access). Many of these risk factors are complex and inter-related; strategies proposed to decrease disparities require multilevel approaches.
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Affiliation(s)
- Emily Brigham
- Division of Pulmonary and Critical Care, Johns Hopkins University, 1830 East Monument Street 5th Floor, Baltimore, MD 21287, USA. https://twitter.com/emily_brigham
| | - Kassandra Allbright
- Department of Medicine, Johns Hopkins University, 1830 East Monument Street 5th Floor, Baltimore, MD 21287, USA
| | - Drew Harris
- Division of Pulmonary and Critical Care and Public Health Sciences, University of Virginia, Pulmonary Clinic 2nd Floor, 1221 Lee Street, Charlottesville, VA 22903, USA.
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Xiao S, Ngo AL, Mendola P, Bates MN, Barcellos AL, Ferrara A, Zhu Y. Household mold, pesticide use, and childhood asthma: A nationwide study in the U.S. Int J Hyg Environ Health 2021; 233:113694. [PMID: 33556714 DOI: 10.1016/j.ijheh.2021.113694] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/13/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the associations of household mold and pesticide use with risk of childhood asthma and examine the potential effect modification by child's sex at a national level in the U.S. METHODS Nationally representative data were drawn from the cross-sectional 2017 and 2018 National Surveys of Children's Health. Household mold and pesticide exposures during the past 12 months and physician-diagnosed childhood asthma were assessed by standard questionnaires administered to primary caregivers. Multivariable logistic regression models were used to calculate adjusted odds ratios (aOR) for current asthma, adjusting for child, caregiver, and household covariates. We also examined potential effect modification by child's sex. Sampling weights accounted for the complex survey design. RESULTS Among 41,423 U.S. children in 2017-2018, the weighted prevalence of current asthma was 10.8% in household mold-exposed children, compared with 7.2% in non-exposed children (P < 0.001). After adjusting for covariates including child's obesity, children with household mold exposure compared to those with no household mold exposure had a 1.41-fold (95% CI: 1.07, 1.87) higher odds of current asthma. Associations between household mold and current asthma were pronounced among boys (aOR 1.57; 95% CI: 1.03-2.38) but not girls (aOR 1.28; 0.90-1.83; P for interaction <0.001). No significant associations were observed between household pesticide use and current asthma, after adjusting for covariates. CONCLUSIONS Our findings suggest that household mold is associated with current asthma among children, independent of other major risk factors including child's obesity status. Our findings may inform strategies targeting mitigation of household mold as an important indoor environment factor to address childhood asthma.
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Affiliation(s)
- Siyuan Xiao
- School of Public Health, University of California, Berkeley, United States
| | - Amanda L Ngo
- Kaiser Permanente Northern California Division of Research, Oakland, CA, United States
| | - Pauline Mendola
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Michael N Bates
- School of Public Health, University of California, Berkeley, United States
| | - Anna L Barcellos
- School of Public Health, University of California, Berkeley, United States
| | - Assiamira Ferrara
- Kaiser Permanente Northern California Division of Research, Oakland, CA, United States
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, United States; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States.
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Castner J, Barnett R, Moskos LH, Folz RJ, Polivka B. Home environment allergen exposure scale in older adult cohort with asthma. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:97-106. [PMID: 32557284 PMCID: PMC7851287 DOI: 10.17269/s41997-020-00335-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/05/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Home environmental exposures are a primary source of asthma exacerbation. There is a gap in decision support models that efficiently aggregate the home exposure assessment scores for focused and tailored interventions. Three development methods of a home environment allergen exposure scale for persons with asthma (weighted by dimension reduction, unweighted, precision biomarker-based) were compared, and racial disparity tested. METHODS Baseline measures from a longitudinal cohort of 187 older adults with asthma were analyzed using humidity and particulate matter sensors, allergy testing, and a home environment checklist. Weights for the dimension reduction scale were obtained from factor analysis, applied for loadings > 0.35. Scales were tested in linear regression models with asthma control and asthma quality of life outcomes. Racial disparities were tested using t tests. Scale performance was tested using unadjusted regression analyses with asthma control and asthma quality of life outcomes, separately. RESULTS The 7-item empirically weighted scale demonstrated best performance with asthma control associations (F = 4.65, p = 0.03, R2 = .02) and quality of life (F = 6.45, p = 0.01, R2 = .03) as follows: evidence of roach/mice, dust, mold, tobacco smoke exposure, properly venting bathroom fan, self-report of roach/mice/rats, and access to a HEPA filter vacuum. Pets indoors loaded on a separate scale. Racial differences were observed (t = - 3.09, p = 0.004). CONCLUSION The Home Environment Allergen Exposure Scale scores were associated with racial disparities. Replicating these methods in populations residing in high-risk/low-income housing may generate a clinically meaningful, tailored assessment of asthma triggers. Further consideration for variables that address allergic reactivity and biomarker results is indicated to enhance the potential for a precision prevention score.
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Affiliation(s)
- Jessica Castner
- Castner Incorporated, Stony Point Road, Grand Island, NY, 14072, USA.
| | - Russell Barnett
- Kentucky Institute for the Environment and Sustainable Development, University of Louisville, Louisville, KY, USA
| | | | - Rodney J Folz
- UH Respiratory Health Center, Chief, Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University & University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Barbara Polivka
- University of Kansas School of Nursing, Kansas City, KS, USA
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