337 - Area Deprivation Index and Clinical and Functional Outcomes in Pediatric Asthma

Poster Number: 337
Publication Number: 337.2075

Background: Asthma is the one of the most common chronic diseases of childhood, disproportionately affecting poor and minoritized children. The Area Deprivation Index (ADI) score, is a validated tool based on a measure created by the Office of Health Resources and Service Administration, and includes information such as census-block data. The ADI score quantifies disadvantaged neighborhoods nationally. Little is known about how neighborhood disadvantage pediatric asthma outcomes among marginalized groups of children.

Objective: To explore the relationship between ADI and clinical and functional asthma outcomes among children living in a historically marginalized community.

Design/Methods: We assessed baseline caregiver-reported data regarding clinical (symptoms, healthcare utilization) and functional (activity limitation, absenteeism) asthma outcomes from a large, school-based asthma trial (Rochester, NY; 2012-2016). We used the validated ADI national score (range 1-100) from https://www.neighborhoodatlas.medicine.wisc.edu/ to assess family neighborhoods. Higher scores indicate worsening scarcity. Bivariate and multivariate analyses assessed outcomes between children living in neighborhoods with low ( < 85) and high (≥85) ADI scores.

Results: We enrolled 400 children with persistent asthma (age 3-10 yrs., participation 79%) and had data for 396 in the analysis. Overall, 38% were female, 32% Hispanic, 58% African American, and 76% had public insurance. Most families (85%) lived in a neighborhood of high ADI, and 25% of children resided in neighborhoods with the highest level of area deprivation (national ranking of 100). Compared to children living in low ADI neighborhoods, children living in high ADI neighborhoods were older, Hispanic, exposed to smoke, had a caregiver with less than a high school education, and had a larger family. In multivariate regression analysis controlling for demographics (Table 1), we found that children living in high bs low ADI neighborhoods had worse nighttime symptoms (4.0 vs. 3.2 symptom-nights/14-days) and more acute asthma visits in prior year (0.69 vs. 0.42). There was no association between ADI and functional outcomes (Table 2).

Conclusion(s): In this sample of children with asthma living in disadvantaged neighborhoods, high ADI scores were associated with more nighttime symptoms and more acute asthma visits. While further investigation is needed to better understand the mechanisms behind these relationships, the impact of residing in an area of high deprivation should be considered when managing asthma for children at high risk for poor outcomes.