Hi. Good afternoon. My name is Justin Jones. I am a second year fellow in pediatric critical care medicine at Children's Hospital Los Angeles. It's an honor to be here. So my project, as you can see here, is entitled Social Vulnerability Index is High and Childhood Opportunity Index is Low in Asthma but Not Linked to PICU Stay. I have no relevant financial disclosures. However, you may notice that the title of my presentation differs slightly from what's in the conference literature. Turns out that being on service in the ICU and trying to meet an abstract deadline means that there is a higher risk for typos. But the correct title is reflected here. So the objectives of my presentation, we're going to review the current literature on social determinants of health in pediatric asthma. We will also discuss the use of the social vulnerability index and the childhood opportunity index as composite geographic measures of social determinants of health in pediatric asthma. We'll also evaluate the relationship between composite measures of social determinants of health and the utilization of the Pediatric Intensive Care Unit for patients with asthma. As I'm sure many of you are aware, asthma is the most common chronic lung disease in children. It affects around 6 million children throughout the United States. Asthma impacts quality of life and is a significant contributor to childhood morbidity and mortality. It may also have significant economic impacts on families through work and school absenteeism and the healthcare costs associated with hospitalizations, ED visits, and medications. Racial disparities in asthma prevalence and severity have also been well documented in the medical literature. Additionally, social determinants of health such as poverty, socioeconomic status, air quality, and access to healthcare as well as neighborhood and community risk factors have been associated with disparities in childhood asthma. The interplay of each of these factors and their contribution to childhood asthma is complex. But given these factors for asthma severity are not evenly distributed across racial and ethnic groups, there is evidence to support that social and economic inequity accounts for a large proportion of the disparities observed in childhood asthma. More recent literature has begun to focus on disparities in area-based composite measures of socioeconomic risk factors in childhood asthma, namely the social vulnerability index and the childhood opportunity index. There is significant literature demonstrating the impact of social determinants of health on the risk of emergency department usage and hospitalizations and asthma. There's also evidence that black race and poverty are associated with increased odds of admission to the pediatric intensive care unit in children with status asthmaticus. Recent literature has demonstrated that composite measures indicating higher social vulnerability are associated with neighborhood hotspots for PICU admission and readmission. However, the association of these composite measures with the risk of ICU admission at initial presentation with status asthmaticus to our knowledge has not been studied. Our aim has been to understand if area-based composite measures of social determinants of health are associated with the severity of asthma disease at presentation and the need for care in pediatric intensive care units. Using composite measures of social vulnerability along with street-level geographic location, we sought to compare patients admitted with status asthmaticus to the pediatric ICU to those admitted to the pediatric ward at Children's Hospital Los Angeles. We hypothesized that patients with a high SVI or social vulnerability index score and a low childhood opportunity index score increased risk for admission to the pediatric intensive care unit for status asthmaticus. Just a little bit of background. The social vulnerability index utilizes U.S. census data to determine social vulnerability of a population at a census tract level. This is more granular than zip code level. Each census tract is ranked based on 15 social factors including poverty, vehicle access, English proficiency, and housing. These are then grouped into four themes which include socioeconomic status, household composition, minority status and language, as well as housing and transportation. Likewise, the childhood opportunity index is a composite index of factors also measured at the census tract level across three domains that influence children's health and development. These are education, health and environment, social, and health. We conducted a retrospective analysis of patients admitted to Children's Hospital Los Angeles for status asthmaticus between January 1, 2017 and March 21, 2022. Patients were identified using ICD-10 codes for asthma. Once we had our cohort, we then filtered the data set to only include patients admitted for status asthmaticus or asthma exacerbation based on chief complaint at the time of presentation. Patients were then sorted according to level of care required ward versus ICU. Any patient requiring a PICU stay during their admission was included in the PICU group regardless of their initial admission location. Children admitted more than once were included in the analysis according to each individual admission. Within the timeframe we evaluated, there were 2,458 individual admissions with 1,661 unique medical record numbers. On unit variant analysis, we found that a higher percentage of black patients were admitted to the ICU than to the ward. We also found that unsurprisingly, ICU admission was associated with a longer hospitalization. Additionally, we found that there was no statistically significant difference in SVI and COI between children admitted to the ward and ICU. However, we did find that all children admitted to Children's Hospital Los Angeles for status asthmaticus had an elevated SVI, overall reflecting a patient population amongst the lowest socioeconomic status in the United States. The median SVI score of .87 indicates a population that is more socially vulnerable than all but 13% of the U.S. population. Similarly, our COI score demonstrates a population amongst those with the lowest childhood opportunity nationwide. When comparing patients with one admission versus multiple admissions, we found that black and Latino children were more likely than white children to have multiple admissions for asthma. We also found that children with government insurance were more likely to have multiple admissions. Additionally, we found that higher SVI and lower COI were associated with multiple admissions for patients in asthma. Our findings do not support our hypothesis that children with a high social vulnerability index score and a low childhood opportunity index score are at increased risk for admission to the pediatric intensive care unit for status asthmaticus. There are several reasons that we hypothesize may be contributing to this. Given the high overall social vulnerability of our population, the effect of socioeconomic factors on severity of illness in our patient cohort may not be as apparent than if our patient population were compared to a less vulnerable group. It's also possible that there are additional patient-level factors that we did not consider. Given that SVI and COI are composite measures composed of multiple thematic domains and indicators, it may be that the impact of individual or household factors contributing to asthma severity are not fully reflected in our findings. While composite measures are helpful to evaluate social vulnerability on a population level, they do not fully reflect individual and household factors such as income, living conditions and exposure to asthma triggers. Lastly, it's possible that SVI and COI are not directly associated with risk for ICU admission and asthma and that patients were admitted to the ward or ICU simply based on their acuity at the time of presentation and the need for therapies available. In conclusion, our findings support previous literature that demonstrates significant racial disparities in patients with asthma. A higher percentage of black children are admitted to the ICU than to the ward. Black and Latino children are more likely than white children to have multiple admissions for asthma. SVI and COI were not associated with ICU admission but were associated with multiple admissions for asthma. And we feel that further research is needed to fully understand the complex relationship between race, socioeconomic factors and the risk of ICU admission in our patients with asthma. I'd just like to take a moment to thank my incredible group of people that have been walking through this research journey with me and I couldn't have done it without their support and help. So I welcome any questions.

Social Vulnerability Index

Childhood Opportunity Index

Pediatric Intensive Care Unit

Pediatric asthma

Racial disparities