Role of social determinants of health in differential respiratory exposure and health outcomes among children

Abstract

Background: Attributes defining the Social Determinants of Health (SDoH) are associated with disproportionate exposures to environmental hazards and differential health outcomes among communities. The dynamics between SDoH, disproportionate environmental exposures, and differential health outcomes are often specific to micro-geographic areas.

Methods: This study focused on children less than 20 years of age who lived in Douglas County, Nebraska, during 2016-2019. To assess the role of SDoH in differential exposures, we evaluated the association between SDoH metrics and criteria pollutant concentrations and the association between SDoH and pediatric asthma exacerbations to quantify the role of SDoH in differential pediatric asthma outcomes. The Bayesian Poisson regression model with spatial random effects was used to evaluate associations.

Results: We identified significant positive associations between the annual mean concentration of criteria pollutants (carbon monoxide, particulate matter_2.5, nitrogen dioxide, sulfur dioxide) with race (Non-Hispanic Black and Hispanic/Latino), financial stability, and literacy. Additionally, there were significant positive associations between higher rates of pediatric asthma emergency department visits and neighborhoods with more Non-Hispanic Black children, children without health insurance coverage, and households without access to a vehicle.

Conclusions: Non-Hispanic Black and Hispanic/Latino children living in Douglas County, NE experience disproportionately higher exposure to criteria pollutant concentrations. Additionally, higher rates of asthma exacerbations among Non-Hispanic Black children could be due to reduced access to respiratory care that is potentially the result of financial instability and vehicle access. These results could inform city planners and health care providers to mitigate respiratory risks among these higher at-risk populations.

Keywords: Asthma disparities; Environmental injustice; Pediatric asthma; Social determinants of health.

Fig. 1

Conceptual framework exploring association between SDoH and pediatric asthma exacerbations. B01001B-Non-Hispanic Black or African American; B01001I-Hispanic or Latino; B06012-Poverty status in the past 12 months; B22002-Household with children and received Food stamps/Supplemental Nutrition Assistance Program; B23007-Households with children under 18 years and unemployed parents; B16010-Households with adults (> 25 years) and education less than high school; B06007-Individuals with limited ability to speak English; B27001-Childern without health insurance; B08201-Households without access to a vehicle. Alpha numeric codes corresponding to each variable are identifiers from the Census data

Fig. 2

The age-adjusted rate of pediatric asthma exacerbations per 10,000 children per year per zip-code area, stratified by gender

Fig. 3

Disproportionate air pollutant exposures: Association between criteria pollutant concentration and SDoH metrics. The x-axis represents median effect estimate and corresponding 95% credible interval. The y-axis represents 9 SDoH metrics included in the analysis. Each facet in this figure correspond to 6 criteria pollutants included in this study. Effect estimates with statistically significant positive associations were highlighted in blue, statistically significant negative associations in black and statistically non-significant association in grey. Statistical significance of the effect estimates was determined based on the variables with 95% credible interval range that do not intersect 1 (dotted line)

Fig. 4

Association between social determinants of health and pediatric asthma exacerbation-related emergency department visits. The x-axis represents the median effect estimates and 2.5–97.5% credible interval; the y-axis represents 10 SDoH metrics. The effect estimates and confidence intervals were generated from the spatial autocorrelation model. The effect estimates with credible intervals that do not intersect 1 (dashed line) were considered significant and are represented using black color and non-significant associations using grey. The effect estimates corresponding to the male population were represented using circles and triangles for females