Association of Social Drivers of Health With Hospitalizations for Pediatric Asthma

OBJECTIVE: Social drivers of health (SDOH) impact health outcomes for children with asthma. Advances in geocoding enable better SDOH measurement in research. We aimed to: 1) examine relationship between three SDOH composite indices-Social Vulnerability Index (SVI), Childhood Opportunity Index 3.0 (COI), Area Deprivation Index (ADI)-and asthma patient disposition from emergency room; and 2) determine which index most closely correlates with admission rates. METHODS: Retrospective cohort study, patients 2-18 years presenting for asthma, defined using computational phenotype requiring: asthma diagnostic code, ≥2 doses nebulized albuterol, and ≥1 systemic steroid dose within 24 h of presentation. Data obtained 2021-2024 from Indiana Network for Patient Care, a state-wide health information exchange. Exposures included three SDOH indices. Mixed effects multinomial logistic regression to evaluate associations with patient disposition and recurrent emergency room encounters. RESULTS: Total 5895 asthma encounters (4485 patients), with 27.85% resulting in admission (57.3% ward, 42.6 ICU). Female gender, chronic illness, "other" preferred language, >1 year since last outpatient visit increased admission likelihood. Black race and preferred language Spanish were associated with lower likelihood (vs. white, English-speaking reference). No SDOH indicator provided superior differentiation of patient disposition. However, census tract-level random effects were meaningful across all three models. CONCLUSIONS: Gender, race, language, chronic comorbidity, and preventive healthcare access are associated with emergency and repeat hospital use in pediatric asthma. Geographic context plays a meaningful role in patients' clinical disposition, but the geographic component driving this association is not meaningfully captured by any of the three SDOH indices studied.