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Pan EJ, Liu JC, Zha AC, Seballos SS, Falcone T, Phelan M, Weleff J. Adverse Childhood Experiences (ACEs) in Unhoused Children Increase Odds of Psychiatric Illness, Physical Illness, and Psychiatric Admission. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:363-372. [PMID: 38938936 PMCID: PMC11199423 DOI: 10.1007/s40653-023-00608-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 06/29/2024]
Abstract
Unhoused children and adolescents have high rates of adverse childhood experiences (ACEs). The objective of this study was to characterize a large cohort of unhoused children and investigate rates of psychiatric diagnoses, medical diagnoses, and utilization of emergency department (ED) resources depending on the presence of additional documented ACEs. A retrospective cohort of all unhoused children who presented to the ED of a large Midwestern health system from January 2014 to July 2019 were included. Unhoused status was determined by address field or ICD-10 code for homelessness (Z59.0). Demographics and ED visits were extracted from the electronic health record. Past medical history, ACEs, chief complaint (CC), length of stay (LOS), imaging, and labs were extracted by chart review. T-tests, chi square tests, and Fisher's exact tests were completed for each sub-analysis. Unhoused children with at least one additional ACE had higher odds of the following psychiatric disorders: depression (OR = 5.2, 95% CI = 3.4- 7.9), anxiety (OR = 3.4, 95% CI = 32.1-5.5), behavioral disorder (OR = 7.2, 95% CI = 35.1- 10.4), psychoses (OR = 6.0, 1.9-18.4), bipolar disorder (OR = 19.8, 95% CI = 34.6-84.9), suicidal ideation (OR = 8.0, 95% CI = 34.8-13.4), post-traumatic stress disorder (OR = 10.1, 95% CI = 35.4-18.6), and attention deficit hyperactive disorder (OR = 4.1, 3.0-5.7). Patients with additional documented ACEs were also more likely to have a prior psychiatric admission (p < 0.001). Unhoused children and adolescents with exposure to additional documented ACEs are more likely to have some serious psychiatric and medical diagnoses compared to other unhoused children.
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Affiliation(s)
- Eric J. Pan
- Department of Psychiatry & Behavioral Neurosciences, Northwestern University, Chicago, IL USA
| | - Jessica C. Liu
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Alexander C. Zha
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH USA
| | - Spencer S. Seballos
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, Cleveland, OH USA
| | - Tatiana Falcone
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH USA
| | - Michael Phelan
- Emergency Services Institute, Cleveland Clinic, Cleveland, OH USA
| | - Jeremy Weleff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
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2
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Baiden P, LaBrenz CA, Broni MN, Baiden JF, Adepoju OE. Prevalence of youth experiencing homelessness and its association with suicidal thoughts and behaviors: Findings from a population-based study. Psychiatry Res 2024; 334:115823. [PMID: 38430817 DOI: 10.1016/j.psychres.2024.115823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
Although various studies have examined factors associated with suicidal behaviors among youth, few studies have investigated the association between youth experiencing homelessness (YEH) and suicidal thoughts and behaviors (STBs) using a large nationally representative sample. The objectives of this study were to investigate prevalence of YEH and its association with STBs. Data for this study came from the 2021 Youth Risk Behavior Survey. An analytic sample of 17,033 youth aged 14-18 (51.7 % male) was analyzed using binary logistic regression. Of the 17,033 youth examined, 3 % experienced homelessness during the past 30 days, 21.3 % experienced suicidal ideation, 17.3 % made a suicide plan, and 10.9 % attempted suicide during the past 12 months. Controlling for demographic characteristics and feeling sad or hopeless, YEH was associated with 2.48 times higher odds of experiencing suicidal ideation (AOR=2.48, p<.001), 2.46 times higher odds of making a suicide plan (AOR=2.46, p<.001), and 4.38 times higher odds of making a suicide attempt (AOR=4.38, p<.001). The findings of this study highlight the importance of identifying youth who are at risk of experiencing homelessness to ensure early interventions are put in place to prevent suicidal behaviors.
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Affiliation(s)
- Philip Baiden
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129, Arlington, TX 76019, United States.
| | - Catherine A LaBrenz
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129, Arlington, TX 76019, United States
| | - Marisa N Broni
- University of Ghana, School of Public Health, P. O. Box LG 25, Legon, Accra, Ghana
| | - John F Baiden
- East Airport International School, P. O. Box KAPM 57, KIA, Accra, Ghana
| | - Omolola E Adepoju
- University of Houston, Tilman J. Fertitta Family College of Medicine, 5055 Medical Circle, Houston, TX 77204, United States
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3
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Gabbay JM, Abrams EM, Nyenhuis SM, Wu AC. Housing Insecurity and Asthma Outcomes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:327-333. [PMID: 37871647 DOI: 10.1016/j.jaip.2023.10.031] [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: 05/16/2023] [Revised: 09/03/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023]
Abstract
Asthma is a chronic respiratory disease with widespread prevalence that affects children, adolescents, and adults. Asthma morbidity and mortality can be exacerbated in the setting of housing insecurity. In this Grand Rounds Review article, we present a case and discuss the implications that housing insecurity has on asthma outcomes in the United States. We then highlight ways in which providers can advocate for patients with asthma and housing insecurity.
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Affiliation(s)
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - Sharmilee M Nyenhuis
- Department of Pediatrics, Section of Allergy and Immunology, University of Chicago, Chicago, Ill
| | - Ann Chen Wu
- Department of Medicine, Boston Children's Hospital, Boston, Mass; Division of Child Health Research and Policy, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
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4
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Goddard J, Montgomerie A, Gialamas A, Haag D, Anderson J, Lynch J. Excess Hospital Burden Among Young People in Contact With Homelessness Services in South Australia: A Prospective Linked Data Study. J Adolesc Health 2023; 73:519-526. [PMID: 37330707 DOI: 10.1016/j.jadohealth.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 03/27/2023] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Youth homelessness remains an ongoing public health issue worldwide. We aimed to describe the burden of emergency department (ED) presentations and hospitalizations among a South Australian population of young people in contact with specialist homelessness services (SHS). METHODS This whole-of-population study used de-identified, linked administrative data from the Better Evidence Better Outcomes Linked Data (BEBOLD) platform on all individuals born between 1996 and 1998 (N = 57,509). The Homelessness2Home data collection was used to identify 2,269 young people in contact with SHS at ages 16-17 years. We followed these 57,509 individuals to age 18-19 years and compared ED presentations and hospital separations related to mental health, self-harm, drug and alcohol, injury, oral health, respiratory conditions, diabetes, pregnancy, and potentially preventable hospitalizations between those in contact and not in contact with SHS. RESULTS Four percent of young people had contact with SHS at ages 16-17 years. Young people who had contact with SHS were 2 and 3 times more likely to have presented to an ED and hospital respectively, compared to those who did not contact SHS. This accounted for 13% of all ED presentations and 16% of all hospitalizations in this age group. Excess burden causes included mental health, self-harm, drug and alcohol, diabetes, and pregnancy. On average, young people in contact with SHS experienced an increased length of stay in ED (+0.6 hours) and hospital (+0.7 days) per presentation, and were more likely to not wait for treatment in ED and to self-discharge from hospital. DISCUSSION The 4% of young people who contacted SHS at ages 16-17 years accounted for 13% and 16% of all ED presentations and hospitalizations respectively at age 18-19 years. Prioritizing access to stable housing and primary health-care services for adolescents in contact with SHS in Australia could improve health outcomes and reduce health-care costs.
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Affiliation(s)
- Joshua Goddard
- BetterStart Health and Development Research Group, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
| | - Alicia Montgomerie
- BetterStart Health and Development Research Group, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Angela Gialamas
- BetterStart Health and Development Research Group, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Dandara Haag
- BetterStart Health and Development Research Group, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jemma Anderson
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia; Department of General and Adolescent Medicine, Women's and Children's Hospital, Adelaide, Australia
| | - John Lynch
- BetterStart Health and Development Research Group, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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5
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Bohnhoff JC, Xue L, Hollander MAG, Burgette JM, Cole ES, Ray KN, Donohue J, Roberts ET. Healthcare Utilization Among Children Receiving Permanent Supportive Housing. Pediatrics 2023; 151:e2022059833. [PMID: 36974602 PMCID: PMC10071430 DOI: 10.1542/peds.2022-059833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Permanent supportive housing (PSH) integrates long-term housing and supports for families and individuals experiencing homelessness. Although PSH is frequently provided to families with children, little is known about the impacts of PSH among children. We examined changes in health care visits among children receiving PSH compared with similar children who did not receive PSH. METHODS We analyzed Pennsylvania Medicaid administrative data for children entering PSH between 2011 and 2016, matching to a comparison cohort with similar demographic and clinical characteristics who received non-PSH housing services. We conducted propensity score-weighted difference-in-differences (DID) analyses to compare changes in health care visits 3 years before and after children entered PSH versus changes in the comparison cohort. RESULTS We matched 705 children receiving PSH to 3141 in the comparison cohort. Over 3 years following PSH entry, dental visits among children entering PSH increased differentially relative to the comparison cohort (DID: 12.70 visits per 1000 person-months, 95% confidence interval: 3.72 to 21.67). We did not find differential changes in preventive medicine visits, hospitalizations, or emergency department (ED) visits overall. When stratified by age, children ≤5 years old at PSH entry experienced a greater decrease in ED visits relative to the comparison cohort (DID: -13.16 visits per 1000 person-months, 95% confidence interval: -26.23 to -0.10). However, emergency visit trends before PSH entry differed between the cohorts. CONCLUSIONS Children in PSH had relatively greater increases in dental visits, and younger children entering PSH may have experienced relative reductions in ED visits. Policymakers should consider benefits to children when evaluating the overall value of PSH.
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Affiliation(s)
- James C. Bohnhoff
- Schools of Medicine
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lingshu Xue
- Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Evan S. Cole
- Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristin N. Ray
- Schools of Medicine
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julie Donohue
- Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eric T. Roberts
- Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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6
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Aggarwal S, Cepalo T, Gill S, Thipse M, Clifton KL, Higginson A, Vu J, Bijelić V, Barrowman N, Giangioppo S, Radhakrishnan D. Factors associated with future hospitalization among children with asthma: a systematic review. J Asthma 2023; 60:425-445. [PMID: 35522051 DOI: 10.1080/02770903.2022.2070762] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Asthma is a leading cause of emergency department (ED) visits and hospitalizations in children, though many could be prevented. Our study objective was to identify factors from the published literature that are associated with future hospitalization for asthma beyond 30 days following an initial asthma ED visit. DATA SOURCES We searched CINAHL, CENTRAL, MEDLINE, and Embase for all studies examining factors associated with asthma-related hospitalization in children from January 1, 1992 to February 7, 2022.Selecting Studies: All citations were reviewed independently by two reviewers and studies meeting inclusion criteria were assessed for risk of bias. Data on all reported variables were extracted from full text and categorized according to identified themes. Where possible, data were pooled for meta-analysis using random effects models. RESULTS Of 2262 studies, 68 met inclusion criteria. We identified 28 risk factors and categorized these into six themes. Factors independently associated with future hospitalization in meta-analysis include: exposure to environmental tobacco smoke (OR = 1.94 95%CI 0.67-5.61), pets exposure (OR = 1.67 95%CI 1.17-2.37), and previous asthma hospitalizations (OR = 3.47 95% CI 2.95-4.07). Additional related factors included previous acute care visits, comorbid health conditions (including atopy), allergen exposure, severe-persistent asthma phenotype, inhaled steroid use prior to ED visit, poor asthma control, higher severity symptoms at ED presentation, warmer season at admission, longer length of stay or ICU admission, and African-American race/ethnicity. CONCLUSIONS We identified multiple factors that are consistently associated with future asthma hospitalization in children and could be used to identify those who would benefit from targeted preventative interventions.
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Affiliation(s)
| | - Tanita Cepalo
- Faculty of Science, Carleton University, Ottawa, Canada
| | - Sana Gill
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Madhura Thipse
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Kerry-Lee Clifton
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - James Vu
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Vid Bijelić
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Sandra Giangioppo
- University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Dhenuka Radhakrishnan
- Children's Hospital of Eastern Ontario, Ottawa, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Canada.,ICES, Ottawa, ON, Canada
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7
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Smith MA, Dinh D, Ly NP, Ward SL, McGarry ME, Zinter MS. Changes in the Use of Invasive and Noninvasive Mechanical Ventilation in Pediatric Asthma: 2009-2019. Ann Am Thorac Soc 2023; 20:245-253. [PMID: 36315585 PMCID: PMC9989865 DOI: 10.1513/annalsats.202205-461oc] [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: 05/26/2021] [Accepted: 10/31/2022] [Indexed: 02/04/2023] Open
Abstract
Rationale: Despite lower overall hospitalization rates for asthma in recent years, there has been an increase in the number of pediatric patients receiving intensive care management in the United States. Objectives: To investigate how the use of invasive and noninvasive mechanical ventilation for asthma has changed in the context of an evolving cohort of critically ill pediatric patients with asthma. Methods: We analyzed children admitted to intensive care units for asthma from 2009 through 2019 in the Virtual Pediatric Systems database. Regression analyses were used to evaluate how respiratory support interventions, mortality, and patient characteristics have changed over time. Odds ratios were calculated to determine how patient characteristics were associated with respiratory support needs. Stratified analyses were performed to determine how changing practice patterns may have differed between patient subgroups. Results: There were 67,614 admissions for 56,727 patients analyzed. Intubation occurred in 4.6% of admissions and decreased from 6.9% to 3.4% over time (P < 0.001), whereas noninvasive ventilation as the maximal respiratory support increased from 8.9% to 20.0% (P < 0.001). Over time, the cohort shifted to include more 2- to 6-year-olds and patients of Asian/Pacific Islander or Hispanic race/ethnicity. Although intubation decreased and noninvasive ventilation increased in all subgroups, the changes were most pronounced in the youngest patients and slightly less pronounced for obese patients. Conclusions: In pediatric asthma, use of intubation has halved, whereas use of noninvasive ventilation has more than doubled. This change in practice appears partially related to a younger patient cohort, although other factors merit exploration.
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Affiliation(s)
| | - Doantrang Dinh
- Division of Pulmonary Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Ngoc P. Ly
- Division of Pulmonology, Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California; and
| | | | - Meghan E. McGarry
- Division of Pulmonology, Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California; and
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8
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Gabbay JM, Stewart AM, Wu AC. Housing Instability and Homelessness-An Undertreated Pediatric Chronic Condition. JAMA Pediatr 2022; 176:1063-1064. [PMID: 36094596 DOI: 10.1001/jamapediatrics.2022.3258] [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] [Indexed: 12/15/2022]
Abstract
This Viewpoint discusses housing instability and homelessness among children as well as the significance of the Housing First model, with particular focus on children in families.
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Affiliation(s)
- Jonathan M Gabbay
- Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Amanda M Stewart
- Harvard Medical School, Boston, Massachusetts.,Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Ann Chen Wu
- Harvard Medical School, Boston, Massachusetts.,Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
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9
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Tannis C, Rajupet S. Differences in disease prevalence among homeless and non-homeless veterans at an urban VA hospital. Chronic Illn 2022; 18:589-598. [PMID: 34162270 DOI: 10.1177/17423953211023959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Approximately 10% of homeless adults in the US are veterans and that number is increasing. Veterans who experience homelessness tend to do so for longer periods compared to non-veterans; and homelessness is associated with more chronic disease complications. We compared the prevalence of five chronic, ambulatory-care sensitive conditions in homeless and domiciled individuals who received primary care at an urban VA hospital. METHODS Data were obtained from the Veteran's Hospital Administration clinical data warehouse. Differences in disease prevalence were compared between the two groups using chi-square analyses and then adjusted for age, gender, race/ethnicity, BMI, and other risk factors where appropriate, using logistic regression. All analyses were conducted using SAS version 9.4. RESULTS Homeless individuals were 46% more likely to have asthma (OR 1.46, 95% CI 1.16-1.84) and 40% more likely to have COPD (OR 1.40, 95% CI 1.14-1.73) after adjustment for age, gender, race/ethnicity, BMI, and tobacco use status. After adjustment for covariates, there was no difference between homeless and domiciled veterans in the prevalence of diabetes, hypertension, or congestive heart failure. DISCUSSION Future quality improvement projects should identify social-environmental risk factors like employment characteristics, and housing quality that can impact chronic respiratory illness prevalence and associated complications.
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Affiliation(s)
- Candace Tannis
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sritha Rajupet
- Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,Health Promotion and Disease Prevention Program, James J. Peters VA Medical Center, Bronx, NY, USA
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10
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O' Brien N, Quinn N, Joyce B, Bedford H, Crushell E. Emergency department utilisation by homeless children in Dublin, Ireland: a retrospective review. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001368. [PMID: 36053629 PMCID: PMC8928284 DOI: 10.1136/bmjpo-2021-001368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/08/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Despite increasing prevalence, European family homelessness remains under-researched. METHODS A retrospective review was performed of homeless children attending a paediatric emergency department in Dublin, Ireland, from 1 January 2017 to 31 December 2020. Comparison was made with a random cohort of 1500 non-homeless paediatric attendances in 2019. Homelessness was defined using the European Typology of Homelessness and Housing Exclusion, including those with addresses of no fixed abode, government homeless accommodation and certain residential settings. The objectives were to compare presentations between homeless and non-homeless children. We were interested in determining differences regarding demographics, healthcare utilisation, clinical presentation and outcomes. RESULTS Of 197 437 attendances 3138 (1.59%) were homeless. Compared with the non homeless, homeless children were less likely to be ethnically Irish (37.4% vs 74.6%, p<0.001) or have been born in Ireland (82.3% vs 96.2%, p<0.001). Irish Travellers (3% vs 0.8%), Roma (22.5% vs 2.4%) and black (21.1% vs 4.2%) ethnicities were over-represented (p<0.001) in the homeless cohort.Homeless children were younger (age <12 months: 26% vs 16%; p<0.001), less likely to be fully vaccinated (73.6% vs 81.9%, p<0.001) and have registered general practitioners (89.7% vs 95.8%, p<0.001). They were more likely to represent within 2 weeks (15.9% vs 10.5%, p<0.001), and use ambulance transportation (13.2% vs 6.7%, p<0.001). Homeless children had lower acuity presentations (triage category 4-5: 47.2% vs 40.7%, p<0.001) and fewer admissions (5.9% vs 8.4%, p<0.001) than non-homeless children. DISCUSSION Infants, Irish Travellers, Roma and black ethnicities were over-represented in homeless presentations. Homeless children had increased reliance on emergency services for primary healthcare needs.
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Affiliation(s)
- Niamh O' Brien
- Paediatric Emergency Medicine, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Nuala Quinn
- Paediatric Emergency Medicine, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Birgitta Joyce
- Paediatric Emergency Medicine, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Helen Bedford
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Ellen Crushell
- Metabolic Medicine, Children's Health Ireland at Temple Street, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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11
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Mitchell HK, Reddy A, Perry MA, Gathers CA, Fowler JC, Yehya N. Racial, ethnic, and socioeconomic disparities in paediatric critical care in the USA. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:739-750. [PMID: 34370979 DOI: 10.1016/s2352-4642(21)00161-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022]
Abstract
In an era of tremendous medical advancements, it is important to characterise and address inequities in the provision of health care and in outcomes. There is a large body of evidence describing such disparities by race or ethnicity and socioeconomic position in critically ill adults; however, this important issue has received less attention in children and adolescents (aged ≤21 years). This Review presents a summary of the available evidence on disparities in outcomes in paediatric critical illness in the USA as a result of racism and socioeconomic privilege. The majority of evidence of racial and socioeconomic disparities in paediatric critical care originates from the USA and is retrospective, with only one prospective intervention-based study. Although there is mixed evidence of disparities by race or ethnicity and socioeconomic position in general paediatric intensive care unit admissions and outcomes in the USA, there are striking trends within some disease processes. Notably, there is evidence of disparities in management and outcomes for out-of-hospital cardiac arrest, asthma, severe trauma, sepsis, and oncology, and in families' perceptions of care. Furthermore, there is clear evidence that critical care research is limited by under-enrolment of participants from minority race or ethnicity groups. We advocate for rigorous research standards and increases in the recruitment and enrolment of a diverse range of participants in paediatric critical care research to better understand the disparities observed, including the effects of racism and poverty. A clearer understanding of when, where, and how such disparities affect patients will better enable the development of effective strategies to inform practice, interventions, and policy.
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Affiliation(s)
- Hannah K Mitchell
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Anireddy Reddy
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, PA, USA
| | - Mallory A Perry
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cody-Aaron Gathers
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jessica C Fowler
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nadir Yehya
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, PA, USA
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12
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Reiter J, Karakis I, Grotto I, Novack L, Haklai Z, Applbaum Y, Steiman A, Gordon ES, Riener E, Kerem E, Cohen-Cymberknoh M. Regional differences in pediatric asthma hospital admissions: National data from Israel 1996-2017. Pediatr Pulmonol 2021; 56:1434-1439. [PMID: 33788990 DOI: 10.1002/ppul.25300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/12/2021] [Accepted: 01/23/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Asthma is a common chronic childhood illness and frequent cause of hospitalization. A decline in hospital admission rates was noted up to the 1990s, however, trends are not as clear since the turn of the century. This study aimed to assess the rates and regional differences of asthma admissions over more than two decades using the national Ministry of Health database, which registers data from all the hospitals. METHODS A retrospective cohort study, analysis of all pediatric asthma admissions, for Patients 1-14 years old, between 1996 and 2017 as recorded by the National Hospital Discharge Registry, was performed. Asthma admission rates were calculated per 1000 age adjusted residents, using the number of admission cases as the numerator, and age specific population size as the denominator. RESULTS The annual asthma hospitalization rate decreased in the entire pediatric population from 2.14 in 1996-0.89 in 2017. Children in the 1-4 year age group comprised most of the hospital admissions, and most of the decline was attributable to this age group. Significant differences in hospitalizations were found between different regions as well as differences in the rate of decline in asthma hospitalizations with the lowest admission rate in the Jerusalem district, highest in Haifa, northern and southern Israeli regions and the greatest rate of decline in the Tel-Aviv district. CONCLUSION This nationwide study, over more than two decades, shows clear regional differences in the rates of asthma admissions as well as regional differences in the rates of decline.
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Affiliation(s)
- Joel Reiter
- Faculty of Medicine, Hebrew University of Jerusalem, Israel.,Pediatric Pulmonary Unit, Department of Pediatrics, Hadassah Medical Center, Jerusalem, Israel
| | - Isabella Karakis
- Environmental Epidemiology Department, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Itamar Grotto
- Health Information Division, Ministry of Health, Jerusalem, Israel
| | - Lena Novack
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Ziona Haklai
- Health Information Division, Ministry of Health, Jerusalem, Israel
| | - Yael Applbaum
- Health Information Division, Ministry of Health, Jerusalem, Israel
| | - Ada Steiman
- Health Information Division, Ministry of Health, Jerusalem, Israel
| | | | - Eva Riener
- Environmental Epidemiology Department, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Eitan Kerem
- Faculty of Medicine, Hebrew University of Jerusalem, Israel.,Pediatric Pulmonary Unit, Department of Pediatrics, Hadassah Medical Center, Jerusalem, Israel
| | - Malena Cohen-Cymberknoh
- Faculty of Medicine, Hebrew University of Jerusalem, Israel.,Pediatric Pulmonary Unit, Department of Pediatrics, Hadassah Medical Center, Jerusalem, Israel
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13
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Sakai-Bizmark R, Mena LA, Estevez D, Webber EJ, Marr EH, Bedel LEM, Yee JK. Health Care Utilization of Homeless Minors With Diabetes in New York State From 2009 to 2014. Diabetes Care 2020; 43:2082-2089. [PMID: 32616618 PMCID: PMC7646203 DOI: 10.2337/dc19-2219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 05/14/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aims to describe differences in health care utilization between homeless and nonhomeless minors with diabetes. RESEARCH DESIGN AND METHODS Data from the Healthcare Cost and Utilization Project's Statewide Inpatient Database from New York for years 2009-2014 were examined to identify pediatric patients <18 years old with diabetes. Outcomes of interest included hospitalization rate, in-hospital mortality, admission through the emergency department (ED), diabetic ketoacidosis (DKA), hospitalization cost, and length of stay (LOS). Other variables of interest included age-group, race/ethnicity, insurance type, and year. Multivariate logistic regression models were used for in-hospital mortality, admission through ED, and DKA. Log-transformed linear regression models were used for hospitalization cost, and negative binomial regression models were used for LOS. RESULTS A total of 643 homeless and 10,559 nonhomeless patients were identified. The hospitalization rate was higher among homeless minors, with 3.64 per 1,000 homeless population compared with 0.38 per 1,000 in the nonhomeless population. A statistically significant higher readmission rate was detected among homeless minors (20.4% among homeless and 14.1% among nonhomeless, P < 0.01). Lower rates of DKA (odds ratio 0.75, P = 0.02), lower hospitalization costs (point estimate 0.88, P < 0.01), and longer LOS (incidence rate ratio 1.20, P < 0.01) were detected among homeless minors compared with nonhomeless minors. CONCLUSIONS This study found that among minors with diabetes, those who are homeless experience a higher hospitalization rate than the nonhomeless. Housing instability, among other environmental factors, may be targeted for intervention to improve health outcomes.
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Affiliation(s)
- Rie Sakai-Bizmark
- The Lundquist Institute for Biomedical Innovation, Torrance, CA .,Department of Pediatrics, Harbor-UCLA Medical Center and David Geffen School of Medicine, University of California, Los Angeles, Torrance, CA
| | - Laurie A Mena
- The Lundquist Institute for Biomedical Innovation, Torrance, CA
| | - Dennys Estevez
- The Lundquist Institute for Biomedical Innovation, Torrance, CA
| | - Eliza J Webber
- The Lundquist Institute for Biomedical Innovation, Torrance, CA
| | - Emily H Marr
- The Lundquist Institute for Biomedical Innovation, Torrance, CA
| | | | - Jennifer K Yee
- The Lundquist Institute for Biomedical Innovation, Torrance, CA.,Department of Pediatrics, Harbor-UCLA Medical Center and David Geffen School of Medicine, University of California, Los Angeles, Torrance, CA
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14
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Landeo-Gutierrez J, Celedón JC. Chronic stress and asthma in adolescents. Ann Allergy Asthma Immunol 2020; 125:393-398. [PMID: 32653405 DOI: 10.1016/j.anai.2020.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/20/2020] [Accepted: 07/06/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE First, to review and critically discuss published evidence on psychosocial stressors, stress, and asthma in adolescents and, then, discuss potential future directions in this field. DATA SOURCES The data source is the National Library of Medicine (PubMed database). STUDY SELECTIONS A literature search was conducted for human studies on stressors or stress and asthma between 2000 and 2020. Studies that were published in English, contained a full text, and included adolescents were considered for inclusion in this review. RESULTS Compared with the available body of evidence in children and adults, relatively few studies have been published in adolescents. Current evidence suggests that exposure to stressors (at the individual, family, and community levels) or stress (acute and chronic) is associated with asthma and worse asthma outcomes, but such evidence must be cautiously interpreted owing to limitations in the design or the analytical approach of the published studies. CONCLUSION Future large studies with a prospective design should determine whether and how stressors or stress causes or worsens asthma in adolescents. At present, clinicians should assess exposure to stressors (eg, violence or abuse) and screen for anxiety and depressive disorders when caring for adolescents with asthma in addition to providing referrals to social workers or mental health professionals when appropriate. Public health policies are needed to reduce psychosocial stressors, such as gun violence and racism, in adolescents.
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Affiliation(s)
- Jeremy Landeo-Gutierrez
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan C Celedón
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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15
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Miao Q, Xiang L, Guan H, Liu Y, Li Z, Ren Y, Xu W. Factors related to disagreement between self-reported versus objective measurement of allergen sensitization at a tertiary pediatric center in Beijing, China. BMC Pediatr 2020; 20:259. [PMID: 32466755 PMCID: PMC7254731 DOI: 10.1186/s12887-020-02148-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 05/14/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The objectives of present study were to examine the level of disagreement between self-reported and objective measurement of sensitization to common inhalant allergens, and to explore the potential risk factors that might contribute to this discrepancy. METHODS A total of 215 children were enrolled from pediatric clinics at a tertiary pediatric center in Beijing, China. A survey questionnaires regarding self-perceived sensitization was completed by participants' parents/caregiver, meanwhile, skin prick testing(SPT) was performed as objective assessment of sensitization. Extent of agreement between self-reported versus SPT-measured sensitization to individual allergen was calculated using Cohen's kappa (κ) coefficient. Multivariable regression analyses were used to determine the factors associated with discrepancy between self-reported and objective measurement of sensitization. RESULTS 119(55.3%) patients have reported to be sensitized to at least one of inhalant allergen, whereas 167(77.7%) patients had a positive skin testing response. Agreement between self-perceived and actual aeroallergen sensitization was moderate for mites(κ = 0.518) and grass pollen mix(κ = 0.451), moreover, fair agreement was observed for mold(κ = 0.316) and cockroach(κ = 0.297), respectively. There was a least agreement between perceived and actual sensitization observed for pet dander, with a kappa coefficient of 0.005. Subjects' age, atopy history, ownership of pet may increase the risk of disagreement, moreover, background factors of informant, like: age, education level, and the relationship with enrolled subjects, were linked to the incidence of disagreement between self-reported sensitization in comparison with SPT results. CONCLUSION Questionnaire-based self-assessment is easy way to collect clinical information on allergen sensitization; however, the accuracy of questionnaire-derived information is more likely to be influenced by respondent's background factors. The information from the questionnaire report is considered to be more reliable when in combination with objective assessment of sensitization, including blood IgE testing and SPT.
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Affiliation(s)
- Qing Miao
- Department of Allergy, Beijng Children's Hospital, Capital Medical Univeristy, National Center for Children's Health, Beijing, 100045, People's Republic of China.
| | - Li Xiang
- Department of Allergy, Beijng Children's Hospital, Capital Medical Univeristy, National Center for Children's Health, Beijing, 100045, People's Republic of China.
| | - Hui Guan
- Department of Allergy, Beijng Children's Hospital, Capital Medical Univeristy, National Center for Children's Health, Beijing, 100045, People's Republic of China
| | - Yongge Liu
- Department of Allergy, Beijng Children's Hospital, Capital Medical Univeristy, National Center for Children's Health, Beijing, 100045, People's Republic of China
| | - Zhen Li
- Department of Allergy, Beijng Children's Hospital, Capital Medical Univeristy, National Center for Children's Health, Beijing, 100045, People's Republic of China
| | - Yixin Ren
- Department of Allergy, Beijng Children's Hospital, Capital Medical Univeristy, National Center for Children's Health, Beijing, 100045, People's Republic of China
| | - Wei Xu
- Department of Allergy, Beijng Children's Hospital, Capital Medical Univeristy, National Center for Children's Health, Beijing, 100045, People's Republic of China
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16
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Beharry MS, Christensen R. Homelessness in Pediatric Populations: Strategies for Prevention, Assistance, and Advocacy. Pediatr Clin North Am 2020; 67:357-372. [PMID: 32122565 DOI: 10.1016/j.pcl.2019.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent data indicate that homelessness among pediatric and adolescent populations is significantly higher than previous studies and point-in-time counts indicate. Pediatricians and other health care providers often see children and youth who are at risk of or are currently experiencing homelessness, but may not be aware of their status. This article summarizes current definitions of homelessness and data on common health issues for pediatric patients. Information on how to recognize and help those experiencing homelessness as well as areas for continued advocacy is shared.
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Affiliation(s)
- Meera S Beharry
- Adolescent Medicine, McLane Children's Medical Center, McLane Children's Specialty Clinic, Baylor Scott and White, 1901 SW H.K. Dodgen Loop, MS-CK-300, Building 300, Temple, TX 76502, USA; Texas A&M Health Science Center (Affiliate), Temple, TX, USA.
| | - Randal Christensen
- Randal Christensen Consulting, LLC, 2654 W Horizon Ridge Parkway Suite B5-113, Henderson, NV 89052, USA. https://twitter.com/AskMeWhyIHurt
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17
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Sease KK, Amati JB. "Housing First" for Optimal Child Health. Pediatrics 2019; 144:peds.2019-0500. [PMID: 31262777 DOI: 10.1542/peds.2019-0500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kerry K Sease
- Department of Pediatrics, School of Medicine Greenville, University of South Carolina, Greenville, South Carolina; and .,Prisma Health Children's Hospital-Midlands, Columbia, South Carolina
| | - J Blakely Amati
- Department of Pediatrics, School of Medicine Greenville, University of South Carolina, Greenville, South Carolina; and.,Prisma Health Children's Hospital-Midlands, Columbia, South Carolina
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