472 - Community-level social adversity as a moderator of the effectiveness of a local evidence-based asthma intervention in the District of Columbia

Publication Number: 472.4226

Jordan Tyris, Children’s National Hospital, Washington, DC, United States; Diane L. Putnick, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States; Shilpa J.. Patel, Children's National Health System, Washington, DC, United States; Stephen J.. Teach, Robert Larner, M.D., College of Medicine at the University of Vermont, Lincoln, VT, United States; Kavita Parikh, Children's National Health System, Washington DC, DC, United States; Edwina Yeung, NICHD, Bethesda, MD, United States

Background: Community-level social adversity (e.g., lower Child Opportunity Index [COI]) is associated with increased pediatric asthma morbidity. Our evidence-based local asthma intervention (IMPACT DC) reduces asthma-related emergency department (ED) use by providing guidelines-based care, referrals to social resources, and care coordination. As lower COI suggests greater social adversity, we hypothesized the IMPACT DC intervention would reduce ED reutilization more for children with lower versus higher COI.

Objective: To evaluate if the COI moderates the association between receiving best practice asthma care in IMPACT DC and ED reutilization for asthma.

Design/Methods: A prospective cohort of children < 16 years with >1 asthma-related ED visit(s) in 2022 was identified using a validated population health asthma registry for Washington, DC. Geocoded addresses were linked to 2021 census-tract COI 3.0 quintiles (moderator), dichotomized into lower (very low/low) and higher (moderate/high/very high) COI. We modelled associations using a recurrent time to event model with IMPACT DC following an ED visit as the exposure and ED reutilization in 2022 as the outcome. Recurrent ED visits were modelled as within-subject, assuming each ED visit is a risk for repeat visits and we tested an interaction between COI/IMPACT DC. Associations were then stratified by COI and adjusted for child age, sex, race/ethnicity (proxy for experienced racism), insurance, ED visit season, and if the child was prescribed an asthma controller medication (proxy for asthma severity).

Results: Among 2,239 children with 3,422 ED visits, 10.9% (n=243 children) received best practice care in IMPACT DC. Of these, 67.2% (n=1,504) experienced lower v. higher COI [Table 1]. Overall, attending IMPACT DC was associated with significantly reduced recurrent ED visits (adjusted hazard ratio [aHR] 0.58, 95%CI [0.46,0.73]). The COI did not moderate the effect of IMPACT DC (p-interaction=0.74), with lower (aHR 0.58 95%CI [0.45,0.75]) v. higher COI (aHR 0.52 95%CI [0.32,0.85]) respectively (Figure 1).

Conclusion(s): In this prospective pediatric asthma cohort, receiving evidence-based, best practice asthma care through IMPACT DC was associated with reduced ED reutilization irrespective of a child’s COI. It is possible this intervention reduced social barriers experienced by children with lower COI that might otherwise create disparities in its effectiveness. Future work can partner with families experiencing social adversity to augment the integration of social and asthma care and to understand how the effectiveness of such care may vary by underlying social adversity.

Table 1: Participant-level characteristics
PAS abstract 11.4.24 Table 1.pdf

Figure 1: Hazard ratios of ED reutilization by IMPACT DC attendance stratified by Child Opportunity Index
PAS abstract 11.4.24 Figure 1.pdf*adjusted for child age, sex, race and ethnicity, insurance type, season of the ED visit, and if they were prescribed an asthma controller medication prior to the study start