Disadvantaged children are more likely to end up in the emergency department (ED) from a virally triggered asthma attack during the back-to-school period, according to new research published in The Journal of Allergy and Clinical Immunology.

Pediatric asthma attacks after summer break are widely known to be driven by viral infections.

When reviewing data from 2016 to 2019 in four Texas cities, researchers found that rates of ED visits for asthma in children aged 5-17 in the first 7 weeks of school were higher in areas with higher scores on the social vulnerability index (SVI). This tool assesses for factors related to socioeconomic status, household characteristics, racial and ethnic minority status, housing type, and access to transportation.

Census tracks (3053) were examined in the study (median population of each, 952). Areas with low SVI scores (SVI = 2) had 378 more asthma-related ED visits per 100,000 person-years during the 7 weeks after school started than the 6 weeks before school started. Areas with moderate social vulnerability had 199 more ED visits whereas areas with high social vulnerability (SVI = 8) had a further 303 ED visits (95% CI, 268-339).

“When children congregate together, we know that there’s a higher likelihood that they can share upper respiratory viruses that then cause infection and lead to a spike in asthma exacerbations leading to ED visits,” said Kristin Kan, MD, MPH, an assistant professor in the Department of Pediatrics at Feinberg School of Medicine, Northwestern University, Chicago, who was not involved in the study. “This paper shows us that phenomenon is differentially presented by neighborhood advantage.”

The data “suggests that viral infections spread faster in more disadvantaged neighborhoods,” the study authors wrote.

According to the researchers, “neighborhood disadvantage may increase the risk of upper respiratory viral infections through mechanisms that increase exposure to viruses, increase susceptibility to viral infections, and increase severity of viral infections.”

Crowding, poor ventilation, lack of access to sick leave for parents resulting in sick children attending school, pollution, exposure to allergens, and psychosocial stress are all potential pathways through which viral infections may occur and spread more readily, the authors said.

Addressing these many aggregated factors requires public health advocacy for better policies, said Darlene Bhavnani, PhD, MPH, an infectious disease epidemiologist at Dell Medical School at The University of Texas at Austin and lead author of the study.

“Advocating for sick leave could be one thing that we do as a community of health professionals so that some schools don’t have more sick kids in them just because their parents work for companies that don’t give leave,” Bhavnani said.

Whenever possible, pediatric clinicians can “help send the message to parents that it’s important to keep kids home when they’re feeling sick,” Bhavnani said.

On a clinical level, Kan doesn’t see the study changing her practice. She already routinely asks asthmatic patients about environmental triggers like cleaning products and pet hair in their home and counsels families on how to address them.

However, the research can “really help move the needle” toward better city planning policies, Kan said.

“At the very least, I hope we don’t ignore the children living in poverty,” Bhavnani said.

This study was funded by the National Center for Advancing Translational Sciences, National Institutes of Health. Kan and Bhavnani reported no disclosures.

Brittany Vargas is a journalist who covers medicine, mental health, and wellness.