社会脆弱性与接受标准化和监管医疗的反复喘息幼儿的预后较差相关。
Social Vulnerability Is Associated with Poorer Outcomes in Preschool Children With Recurrent Wheezing Despite Standardized and Supervised Medical Care.
机构信息
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Ga.
Division of Biostatistics and Bioinformatics, Pennsylvania State University, Hershey, Pa.
出版信息
J Allergy Clin Immunol Pract. 2022 Apr;10(4):994-1002. doi: 10.1016/j.jaip.2021.12.043. Epub 2022 Feb 2.
BACKGROUND
Social determinants of health are associated with disparate asthma outcomes in school-age children. Social determinants have not been studied in preschool children with recurrent wheezing.
OBJECTIVE
We hypothesized that preschool children with recurrent wheezing at highest risk of social vulnerability would have more frequent symptoms and exacerbations when followed over 1 year, despite receiving standardized and supervised asthma care.
METHODS
A multicenter population of adherent preschool children receiving standardized and supervised care for wheezing was stratified by a composite measure of social vulnerability based on individual-level variables. Primary outcomes included days with upper respiratory infections and days with asthma symptom flares. Other outcomes included symptom scores during upper respiratory infections and respiratory symptom flare days, exacerbation occurrence, quality of life during the exacerbation, and hospitalization.
RESULTS
Preschool children at highest risk of social vulnerability did not have more frequent upper respiratory infections, respiratory symptoms, or exacerbations, but instead had more severe symptoms during upper respiratory infections and respiratory flare days, as well as more severe exacerbations with significantly poorer caregiver quality of life. Children at highest risk of social vulnerability also lived in poorer housing conditions with differing exposures and self-reported triggers.
CONCLUSIONS
Individual-level social determinants of health reflecting social vulnerability are associated with poorer outcomes in preschool children with recurrent wheezing despite access to supervised and standardized care. Comprehensive assessment of social determinants of health is warranted in even the youngest children with wheezing, because mitigation of these social inequities is an essential first step toward improving outcomes in pediatric patients.
背景
健康的社会决定因素与学龄儿童哮喘结局的差异有关。尚未研究有反复喘息的学龄前儿童的社会决定因素。
目的
我们假设，在接受标准化和监督管理的喘息学龄前儿童中，社会脆弱性风险最高的儿童，尽管接受了标准化和监督管理，但在随访 1 年期间，其症状和加重的发生频率更高。
方法
在一项多中心研究中，根据个人层面的变量，对接受标准化和监督管理的有反复喘息的依从性学龄前儿童进行了社会脆弱性综合指标分层。主要结局指标包括上呼吸道感染天数和哮喘症状加重天数。其他结局指标包括上呼吸道感染期间和呼吸道症状加重期间的症状评分、加重的发生情况、加重期间的生活质量以及住院情况。
结果
社会脆弱性风险最高的学龄前儿童上呼吸道感染、呼吸道症状或加重的频率并没有增加，但上呼吸道感染和呼吸道加重期间的症状更严重，并且加重的情况更严重，导致照顾者的生活质量明显下降。社会脆弱性风险最高的儿童居住的住房条件较差，接触和自我报告的触发因素也不同。
结论
尽管接受了监督和标准化的治疗，但反映社会脆弱性的健康的社会决定因素与反复喘息的学龄前儿童的不良结局有关。即使是患有喘息的最小的儿童，也需要全面评估社会决定因素的健康状况，因为减轻这些社会不平等是改善儿科患者结局的重要第一步。
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