Division of Pulmonary Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Pediatr. 2023 Jun 1;35(3):337-343. doi: 10.1097/MOP.0000000000001235. Epub 2023 Mar 2.
The current review provides an assessment of the recent pediatric literature evaluating socioeconomic drivers of asthma incidence and morbidity. The review addresses the specific social determinants of health related to housing, indoor and outdoor environmental exposures, healthcare access and quality, and the impact of systematic racism.
Many social risk factors are associated with adverse asthma outcomes. Children living in low-income, urban neighborhoods have greater exposure to both indoor and outdoor hazards, including molds, mice, second-hand smoke, chemicals, and air pollutants, all of which are associated with adverse asthma outcomes. Providing asthma education in the community - via telehealth, school-based health centers, or peer mentors - are all effective methods for improving medication adherence and asthma outcomes. The racially segregated neighborhoods created by the racist 'redlining' policies implemented decades ago, persist today as hotspots of poverty, poor housing conditions, and adverse asthma outcomes.
Routine screening for social determinants of health in clinical settings is important to identify the social risk factors of pediatric patients with asthma. Interventions targeting social risk factors can improve pediatric asthma outcomes, but more studies are needed related to social risk interventions.
本综述评估了最近有关评估哮喘发病率和发病率的社会经济驱动因素的儿科文献。该综述涉及与住房、室内和室外环境暴露、医疗保健的可及性和质量以及系统种族主义有关的特定健康社会决定因素。
许多社会风险因素与不良哮喘结局相关。居住在低收入、城市社区的儿童接触到更多的室内和室外危害,包括霉菌、老鼠、二手烟、化学物质和空气污染物,所有这些都与不良哮喘结局相关。通过远程医疗、学校保健中心或同伴导师在社区中提供哮喘教育是提高药物依从性和哮喘结局的有效方法。几十年前实施的种族主义“红线”政策所造成的种族隔离社区,今天仍然是贫困、住房条件差和不良哮喘结局的热点地区。
在临床环境中对健康的社会决定因素进行常规筛查,对于识别患有哮喘的儿科患者的社会风险因素很重要。针对社会风险因素的干预措施可以改善儿科哮喘的结局,但需要更多与社会风险干预相关的研究。