TOPLINE

Children’s gender, race, preferred language, chronic health conditions, and recent visits to primary care or pulmonology were associated with where they went after an emergency department (ED) asthma visit — home, a regular ward, or the ICU. Neighborhood of residence was also linked to outcomes, but none of the three social drivers of health indices examined explained the geographic pattern.

METHODOLOGY

• Researchers conducted a retrospective cohort study to evaluate the relationship between the social drivers of health indices and acute asthma among children aged 2-18 years presenting to EDs in Indiana between 2021 and 2024.
• A total of 5895 asthma encounters involving 4485 unique children were analyzed; children were identified using an asthma diagnostic code and treatment with at least two doses of nebulized albuterol and a systemic steroid dose within 24 hours of presentation to the ED.
• Exposures were three common composite indices — the Social Vulnerability Index (range, 0-1; higher scores indicate greater vulnerability), the Childhood Opportunity Index version 3.0 (range, 1-100; lower scores indicate reduced opportunity), and the Area Deprivation Index version 4.0.1 (range, 1-10; higher scores indicate greater deprivation). Indices were linked to children’s residential addresses via geocoding.
• The primary outcome was ED disposition, classified as discharge home, admission to an inpatient ward, or admission to the pediatric ICU.

TAKEAWAY

• In adjusted analyses, girls were more likely than boys to be admitted to a general ward (odds ratio [OR], 1.3) or the pediatric ICU (OR, 1.4; P < .0001 for both).
• Black children were less likely than White children to be admitted to the ward (OR, 0.50) or pediatric ICU (OR, 0.66); children whose families preferred Spanish were also less likely to be admitted to the ward (OR, 0.54) or pediatric ICU (OR, 0.59), whereas children who had seen a primary care provider or pulmonologist within the previous year were more likely to be admitted to the ward (OR, 1.3; P < .05 for all).
• Children with genetic or neuromuscular conditions or chronic lung disease were much more likely to need ward or ICU admission (P < .0001 for all).
• None of the three composite indices predicted admission, but modest yet meaningful neighborhood patterns in the risk for admission were present and were not captured by the indices.

IN PRACTICE

“We found that race, preferred language, chronic comorbidity, and preventive healthcare access emerged as significant drivers associated with initial emergency department utilization, with the addition of insurance type contributing to repeat encounters, underscoring the critical need for structural interventions that address systemic inequities,” the authors of the study wrote.

SOURCE

This study was led by Amy E. Hanson, of Indiana University School of Medicine, Indianapolis. It was published online on August 3, 2026, in Pediatric Pulmonology.

LIMITATIONS

This study was retrospective in nature, and data were drawn from a database, not using manual extraction. Secondary diagnoses were determined from diagnostic codes and could have been missed or misclassified. The study covered the COVID pandemic and the early postpandemic period.

DISCLOSURES

This study was funded by the Children’s Health Services Research Division at Indiana University School of Medicine and the Riley Critical Care Research Grant. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.