Role of social determinants of health in differential respiratory exposure and health outcomes among children

Jagadeesh Puvvula; Jill A Poole; Yeongjin Gwon; Eleanor G Rogan; Jesse E Bell

doi:10.1186/s12889-022-14964-2

Role of social determinants of health in differential respiratory exposure and health outcomes among children

BMC Public Health. 2023 Jan 17;23(1):119. doi: 10.1186/s12889-022-14964-2.

Authors

Jagadeesh Puvvula¹, Jill A Poole², Yeongjin Gwon³, Eleanor G Rogan⁴, Jesse E Bell^{4

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Affiliations

¹ Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA. jagadeesh.puvvula@unmc.edu.
² Division of Allergy and Immunology, Department of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
³ Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
⁴ Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
⁵ School of Natural Resources, University of Nebraska-Lincoln, Lincoln, NE, USA.
⁶ Daugherty Water for Food Global Institute, University of Nebraska, Lincoln, NE, USA.

Abstract

Background: Attributes defining the Social Determinants of Health (SDoH) are associated with disproportionate exposures to environmental hazards and differential health outcomes among communities. The dynamics between SDoH, disproportionate environmental exposures, and differential health outcomes are often specific to micro-geographic areas.

Methods: This study focused on children less than 20 years of age who lived in Douglas County, Nebraska, during 2016-2019. To assess the role of SDoH in differential exposures, we evaluated the association between SDoH metrics and criteria pollutant concentrations and the association between SDoH and pediatric asthma exacerbations to quantify the role of SDoH in differential pediatric asthma outcomes. The Bayesian Poisson regression model with spatial random effects was used to evaluate associations.

Results: We identified significant positive associations between the annual mean concentration of criteria pollutants (carbon monoxide, particulate matter_2.5, nitrogen dioxide, sulfur dioxide) with race (Non-Hispanic Black and Hispanic/Latino), financial stability, and literacy. Additionally, there were significant positive associations between higher rates of pediatric asthma emergency department visits and neighborhoods with more Non-Hispanic Black children, children without health insurance coverage, and households without access to a vehicle.

Conclusions: Non-Hispanic Black and Hispanic/Latino children living in Douglas County, NE experience disproportionately higher exposure to criteria pollutant concentrations. Additionally, higher rates of asthma exacerbations among Non-Hispanic Black children could be due to reduced access to respiratory care that is potentially the result of financial instability and vehicle access. These results could inform city planners and health care providers to mitigate respiratory risks among these higher at-risk populations.

Keywords: Asthma disparities; Environmental injustice; Pediatric asthma; Social determinants of health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Asthma* / epidemiology
Bayes Theorem
Child
Environmental Pollutants*
Humans
Outcome Assessment, Health Care
Social Determinants of Health

Substances

Environmental Pollutants