Why coordination is the key to addressing SDoH-related asthma triggers
Today is World Asthma Day, and on this day, we are reminded that the social determinants of health (SDoH) have a significantly adverse effect on children and adults who are exposed to environmental factors like allergens, tobacco smoke, and indoor and outdoor air pollution. Asthma is a major contributor to disease and disability in children, and social factors have given rise to unhealthy residential environments where risk factors of asthma are clustered.
Studies show that there is a pattern in asthma risk based on race and socioeconomic factors. Many individuals and families living in poverty are more likely to be exposed to polluted air and water, reside in noisier, lower quality, and more crowded homes and live in more dangerous neighborhoods with physical deterioration and poorer city services.
The reality is that asthma triggers are largely avoidable. According to the Centers for Disease Control and Prevention (CDC), “asthma accounts for 11 million doctor’s office visits, 439,435 discharges from hospital inpatient care and 1.7 million emergency department (ED) visits each year”. Each day, ten Americans die from asthma, and in 2015, 3,615 people died from asthma. Many of these deaths are avoidable with proper treatment and care.
By addressing the underlying SDoH factors that can exacerbate asthma and partnering with community-based organizations (CBOs) to coordinate care, healthcare organizations (HCOs) can help bring relief to those individuals and families impacted by this chronic illness.
SDoH Leads to Asthma Exacerbation
Studies show that housing is the main SDoH contributor to asthma. Inadequate housing is linked to increased indoor allergen exposure and higher asthma morbidity and mortality, particularly for low-income racial/ethnic minority children living in urban areas. Findings from a cross-sectional study among children <6 years of age revealed that roughly 39 percent of doctor-diagnosed cases of asthma among children in the United States are avoidable by eliminating indoor environmental exposures.
Another study also found that low-income minority populations are more affected by these factors. Researchers studied 140 lower-income households with an asthmatic child in the Kansas City region and assigned their living environments a concern-level score with zero as no concern and 53 as the highest. Households of those who identified as Latino had an 18.7 concern score, and those identifying as Black had a 17.8 score, while non-Latino white households had a 13.2 score and an unclassified group scored 13.3.
While poor indoor housing conditions can trigger asthma symptoms, a comprehensive literature analysis indicates that other SDoH domains play a role as well. The analysis found that food insecurity, exposure to violence, and poor neighborhood quality can heighten vulnerability to environmental agents. For example, children exposed to violence in an environment with higher levels of air pollution had 1.6- to 2.4-fold higher rates of asthma diagnosis. Similarly, increased family stress combined with traffic-related pollution exposure predicts increased asthma symptoms.
HCOs and CBOs Partner to Address SDoH-Related Asthma Triggers
HCOs all over the U.S. are tackling the social factors contributing to the worsening asthma conditions by partnering with CBOs. For example, Sinai Health System’s Urban Health Institute (SUHI), works with community members and organizations to develop community health interventions and provides a broad scope of evaluation services—including for asthma patients. In 2010, SUHI partnered with the Chicago Housing Authority (CHA) to develop the Helping Children Breathe and Thrive in Chicago’s Public Housing (HCBT) program. As part of the program, community health workers were trained to conduct comprehensive asthma and healthy homes education. Adults received four home visits over the course of six months and children received five to six home visits over the course of one year. In the first year, the program resulted in an 83 percent decrease in ED visits and 75.8 percent decrease in overall urgent health care utilization.
Another healthcare provider, Boston Children’s Hospital, developed a Community Asthma Initiative (CAI) to provide asthma case management and home visits for children from low-income neighborhoods in Boston, with a focus on addressing racial/ethnic health disparities in pediatric asthma outcomes. A study of the program notes that “strong partnerships with public health, community, and housing agencies have allowed CAI to leverage its outcomes to expand systemic changes locally and statewide to reduce asthma morbidity.” The study also found that CAI decreased the number of children with any asthma-related hospitalizations by 79 percent after 12 months and reduced asthma-related emergency department visits by 56 percent among children served, most of whom were non-Hispanic black or Hispanic. Hospital administrative data also indicate that the number of asthma-related hospitalizations per child significantly decreased among CAI participants compared with a control group.
Holistic Care Requires Care Coordination
Emergencies related to avoidable chronic conditions can be costly and can turn into a vicious cycle of clinical care that does not address the root of the problem: SDoH.
HCOs understand the impact of SDoH on overall health outcomes, but many organizations are unclear about how to approach SDoH interventions. A 2017 survey, found that physicians who felt they should help address these issues said they probably weren't in a position to do anything. For example, 48 percent said physician offices were not capable of helping patients find affordable housing. The solutions to this problem lie beyond the walls of clinical care. To improve patient outcomes, especially for chronic diseases, HCOs must partner with CBOs to coordinate care. By partnering with CBOs, HCOs are better positioned to address SDoH within their communities. Because CBOs are closely embedded in the community and have the capacity to provide nonclinical, social support to address SDoH, CBOs can fill a critical gap in care coordination.
To learn more about addressing SDoH and partnering with CBOs to drive SDoH interventions, download our white paper, Overcoming Obstacles: Challenges & Solutions for Providers Addressing SDoH. In this white paper, we explore some of the central challenges providers face when addressing the social determinants of health and high-level solutions to overcome them.