Division of Hospital Medicine, Children's National Hospital, Washington, DC.
George Washington University School of Medicine and Health Sciences, Washington, DC.
JAMA Pediatr. 2022 Feb 1;176(2):e215103. doi: 10.1001/jamapediatrics.2021.5103. Epub 2022 Feb 7.
Social determinants of health (SDOH) correlate with pediatric asthma morbidity, yet whether interventions addressing social risks are associated with asthma outcomes among children is unclear.
To catalog asthma interventions by the social risks they address and synthesize their associations with asthma-related emergency department (ED) visits and hospitalizations among children.
PubMed, Scopus, PsycINFO, SocINDEX, CINAHL, and references of included full-text articles were searched from January 1, 2008, to June 16, 2021.
Included articles were US-based studies evaluating the associations of interventions addressing 1 or more social risks with asthma-related ED visits and hospitalizations among children. The systematic review included 38 of the original 641 identified articles (6%), and the meta-analysis included 19 articles (3%).
Data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. The SDOH intervention clusters were identified by grouping studies according to the social risks they addressed, using the Healthy People 2020 SDOH framework. Random-effects models created pooled risk ratios (RRs) as the effect estimates.
Patients with ED visits or hospitalizations were the primary outcomes. Subgroup analyses were conducted by an SDOH intervention cluster. Sensitivity analyses were conducted for each, removing outlier studies and studies failing to meet the minimum quality threshold.
In total, 38 studies were included in the systematic review, with 19 of these studies providing data for the meta-analysis (5441 participants). All interventions addressed 1 or more of the health, environment, and community domains; no interventions focused on the economy or education domains. In the primary analysis, social risk interventions were associated with decreased ED visits (RR, 0.68; 95% CI, 0.57-0.81; I2 = 70%) and hospitalizations (RR, 0.50; 95% CI, 0.37-0.68; I2 = 69%). In subgroup analyses, the health, environment, and community intervention cluster produced the lowest RR for ED visits (RR, 0.53; 95% CI, 0.44-0.64; I2 = 50%) and for hospitalizations (RR, 0.33; 95% CI, 0.20-0.55; I2 = 71%) compared with other intervention clusters. Sensitivity analyses did not alter primary or subgroup effect estimates.
The results of this systematic review and meta-analysis indicate that social risk interventions are associated with decreased asthma-related ED visits and hospitalizations among children. These findings suggest that addressing social risks may be a crucial component of pediatric asthma care to improve health outcomes.
健康的社会决定因素（SDOH）与儿科哮喘发病率相关，但针对社会风险的干预措施是否与儿童哮喘结局相关尚不清楚。
根据所解决的社会风险对哮喘干预措施进行分类，并综合评估这些干预措施与儿童哮喘相关急诊就诊（ED）和住院之间的关联。
从 2008 年 1 月 1 日至 2021 年 6 月 16 日，在 PubMed、Scopus、PsycINFO、SocINDEX、CINAHL 和纳入的全文文章参考文献中检索了数据。
纳入的文章为评估解决 1 种或多种社会风险的干预措施与儿童哮喘相关 ED 就诊和住院之间关联的美国研究。系统综述纳入了最初 641 篇文章中的 38 篇（6%），荟萃分析纳入了 19 篇文章（3%）。
根据所解决的社会风险对研究进行分组，使用《健康人民 2020 年 SDOH 框架》确定 SDOH 干预聚类，遵循系统评价和荟萃分析报告规范进行数据提取。随机效应模型创建了汇总风险比（RR）作为效应估计值。
ED 就诊或住院的患者为主要结局。根据 SDOH 干预聚类进行亚组分析。对每项分析进行敏感性分析，剔除异常值研究和未达到最低质量阈值的研究。
共纳入 38 项系统评价研究，其中 19 项研究提供了荟萃分析数据（5441 名参与者）。所有干预措施都解决了 1 个或多个健康、环境和社区领域的问题；没有干预措施专注于经济或教育领域。在主要分析中，社会风险干预措施与 ED 就诊（RR，0.68；95%CI，0.57-0.81；I2=70%）和住院（RR，0.50；95%CI，0.37-0.68；I2=69%）的减少相关。在亚组分析中，健康、环境和社区干预聚类在 ED 就诊（RR，0.53；95%CI，0.44-0.64；I2=50%）和住院（RR，0.33；95%CI，0.20-0.55；I2=71%）方面产生的 RR 最低，与其他干预聚类相比。敏感性分析并未改变主要或亚组的效果估计值。
本系统评价和荟萃分析的结果表明，社会风险干预措施与儿童哮喘相关的 ED 就诊和住院减少相关。这些发现表明，解决社会风险可能是改善儿童哮喘护理健康结局的重要组成部分。
