Social determinants of health influence preschool and caregiver experiences during symptoms and exacerbations of wheezing

Abstract

Background: Social determinants of health have been inadequately studied in preschool children with wheezing and their caregivers but may influence the care received.

Objective: To evaluate the symptom and exacerbation experiences of wheezing preschool children and their caregivers, stratified by risk of social vulnerability, over 1 year of longitudinal follow-up.

Methods: A total of 79 caregivers and their preschool children with recurrent wheezing and at least 1 exacerbation in the previous year were stratified by a composite measure of social vulnerability into "low" (N = 19), "intermediate" (N = 27), and "high" (N = 33) risk groups. Outcome measures at the follow-up visits included child respiratory symptom scores, asthma control, caregiver-reported outcome measures of mental and social health, exacerbations, and health care utilization. The severity of exacerbations reflected by symptom scores and albuterol use and exacerbation-related caregiver quality of life were also assessed.

Results: Preschool children at high risk of social vulnerability had greater day-to-day symptom severity and more severe symptoms during acute exacerbations. High-risk caregivers were also distinguished by lower general life satisfaction at all visits and lower global and emotional quality of life during acute exacerbations which did not improve with exacerbation resolution. Rates of exacerbation or emergency department visits did not differ, but intermediate- and high-risk families were significantly less likely to seek unscheduled outpatient care.

Conclusion: Social determinants of health influence wheezing outcomes in preschool children and their caregivers. These findings argue for routine assessment of social determinants of health during medical encounters and tailored interventions in high-risk families to promote health equity and improve respiratory outcomes.

Figure 1.

Child symptom scores (A) at each follow-up visit, (B) merged across all visits, and (C) stratified by caregiver reported “breathing problems” since the last study visit in children at low risk (blue), intermediate risk (orange), and high risk (pink) of social vulnerability. Boxplot lines and whiskers reflect the median and 5^th-95^th percentile, respectively. *p<0.05 for high risk vs. low risk; #p<0.05 versus breathing problems not reported, for same groups.

Figure 2.

Caregiver general life satisfaction T-scores at each study visit, in caregivers at low risk (blue), intermediate risk (orange), and high risk (pink) of social vulnerability. Boxplot lines and whiskers reflect the median and 5^th-95^th percentile, respectively. *p<0.05 for pairwise comparisons. Comparisons that are not marked are not statistically significant.

Figure 3.

Diary-reported (A) child symptom scores and (B) inhalations of albuterol sulfate over the course of an exacerbation treated with prednisolone in children at low risk (blue), intermediate risk (orange), and high risk (pink) of social vulnerability. *p<0.05 for high risk vs. low risk, #p<0.05 for high risk vs. intermediate risk.

Figure 4.

Pediatric asthma caregiver quality of life (PACQLQ) (A) global scores (B) emotional domain scores and (C) activity domain scores in caregivers at low risk (blue), intermediate risk (orange), and high risk (pink) of social vulnerability on exacerbation days one, six and fifteen. Boxplot lines and whiskers reflect the median and 5^th-95^th percentile, respectively. *p<0.05 for pairwise comparisons. Comparisons that are not marked are not statistically significant.