摘要：Objectives. We assessed whether geographic information available at the time of asthma admission predicts time to reutilization (readmission or emergency department revisit). Methods. For a prospective cohort of children hospitalized with asthma in 2008 and 2009 in Cincinnati, Ohio, we constructed a geographic social risk index from geocoded home addresses linked to census tract extreme poverty and high school graduation rates and median home values. We examined geographic risk associations with reutilization and caregiver report of hardship. Results. Thirty-nine percent of patients reutilized within 12 months. Compared with those in the lowest geographic risk stratum, those at medium and high risk had 1.3 (95% confidence interval [CI] = 0.9, 1.9) and 1.8 (95% CI = 1.4, 2.4) the risk of reutilization, respectively. Caregivers of children at highest geographic risk were 5 times as likely to report more than 2 financial hardships ( P < .001) and 3 times as likely to report psychological distress ( P = .001). Conclusions. A geographic social risk index may help identify asthmatic children likely to return to the hospital. Targeting social risk assessments and interventions through geographic information may help to improve outcomes and reduce disparities. Asthma morbidity and acute health service utilization vary geographically. 1–7 Neighborhood characteristics, including socioeconomic status, have been shown to be strongly associated with asthma morbidity. 3,4,7–10 Studies demonstrate that area-based, or geographic, socioeconomic characteristics approximate individual-level characteristics. 11,12 Such measures are used to illustrate and monitor socioeconomic inequalities and demonstrate strong gradients for multiple health outcomes. 13–16 The use of geographic data to understand population-level rates of disease is a powerful tool, but to our knowledge, such information has not been used to inform care at the individual level. Individual-level differences in socioeconomic status are strongly associated with disparate outcomes in pediatric asthma morbidity. 5,17,18 Still, clinical care guidelines do little to identify and mitigate underlying social and economic risks. 19 Early identification of children at increased risk could allow for more effective targeting of resources prior to discharge. Efficiently targeting scarce hospital and community resources is increasingly important as clinicians seek to reduce acute health service utilization without increasing costs or lengths of stay. 20 We assessed a novel and efficient way to stratify children with asthma at the time of admission to identify those at highest risk of further morbidity. Specifically, we examined whether area-based socioeconomic measures could be used to identify children at highest risk for further asthma-related utilization (readmission or return to the emergency department [ED]). We also assessed whether risk level derived from geographic data was associated with actual household-level financial hardships and caregiver psychological distress, factors that are associated with asthma morbidity and potentially amenable to intervention. 5,21,22
