Exploring the Effects of Chicago's Health Care Disparities and Continued Segregation in Children With Asthma

Background/Significance:

Research is increasingly examining how social determinants affect health. The CDC’s Social Vulnerability Index (SVI) and the Child Opportunity Index (COI) assess neighborhood risk and resources, respectively. However, no study has yet explored how SVI and COI relate to asthma outcomes in children treated at two demographically distinct sister hospitals in Chicago.

Purpose:

The purpose of this study is to determine if children admitted to Advocate Children's Hospital, ACH (Park Ridge or Oak Lawn) with status asthmaticus or acute asthma exacerbation have worse outcomes (longer lengths of stay, higher prism 3 scores, higher rates of mechanical ventilation or ECMO, more use of adjunctive therapies, higher readmission rates, and higher odds of mortality) based on the SVIs and the COIs.

Methods:

This is a retrospective study utilizing the Virtual Pediatric Systems (VPS) database obtaining subjects admitted from Dec 2020 to Dec 2023 with the diagnosis of status asthmaticus or acute asthma exacerbation

Results:

The study included 75 subjects from Oak Lawn and 277 subjects from Park Ridge, with a mean age of 11.94 and 9.12, respectively. The cohort was diverse, with nearly equal sex distribution and a race predominance of black individuals (69%) admitted to Oak Lawn, and white (60%) admitted to Park Ridge. The average hospital stay for Oak Lawn and Park Ridge was 2.5 and 3.63 days, respectively. Social vulnerability was low at both campuses, with most patients scoring 0 on vulnerability indices. Most of the subjects admitted to Park Ridge were from areas with a high child opportunity index (27%). The mean COI score from subjects admitted to Park Ridge Hospital was 55. Whereas, the majority of subjects admitted to Oak Lawn were mostly from areas with a very low child opportunity index (39%) and a mean COI score of 34.

Conclusion:

The study was limited by a small sample size, which constrained its ability to fully capture the scope of the issue. A larger sample size could have provided more robust results. The study was also conducted within a single hospital system, which may limit its generalizability. Future research should consider including pediatric intensive care units across multiple hospital systems in Chicago to better represent the diverse population.