title: Medical and Social Determinants of Health Associated with Intensive Care Admission for Asthma in Children.
abstract: Risk factors for severe asthma exacerbations in children requiring admission to the intensive care unit (ICU) may occur in variety of medical, environmental, economic, and socioeconomic domains.
  
  
  
  We sought to characterize medical and sociodemographic risk factors among children who required admission to the intensive care unit for asthma.
  
  
  
  Data were obtained from the Greater Cincinnati Asthma Risk Study, a population-based, prospective, observational cohort of children admitted for treatment of acute asthma or bronchodilator-responsive wheezing. Data collected on 774 children included race, socioeconomic status, allergen sensitization, environmental exposures, psychosocial strain, and financial hardship. Analyses compared children admitted to the ICU to those admitted to a medical inpatient unit.
  
  
  
  One hundred sixty-one (20.9%) children required admission to intensive care. There was no difference in sex, race, insurance status, caregiver educational level, income, financial strain, psychological distress, or marital status between the ICU and non-ICU cohorts. Risk for medication nonadherence assessed by parent report was not different between groups. Although previous hospital admission or emergency department visit history did not differ between the groups, prior ICU admission was more common among those admitted to the ICU at the index admission (27 vs. 16%, P = 0.002). Children requiring intensive care admission were more likely to be sensitized to multiple aeroallergens. Exposure to cigarette smoke (measured as salivary cotinine), although a risk factor for hospital admission, was negatively associated with risk of ICU admission.
  
  
  
  Social and economic risk factors typically predictive of increased asthma morbidity, including exposure to tobacco smoke, were not associated with ICU admission among a population of children admitted to the hospital for treatment of acute asthma. Intrinsic disease factors, including allergic sensitization, may be more important predictors of ICU admission.
authors.affiliation: 1 Division of Pulmonary Medicine.
authors.forename: Karen M
authors.initials: KM
authors.lastname: McDowell
authors.affiliation: 1 Division of Pulmonary Medicine.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Kercsmar
authors.affiliation: 2 Department of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Bin
authors.initials: B
authors.lastname: Huang
authors.affiliation: 1 Division of Pulmonary Medicine.
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Guilbert
authors.affiliation: 3 Division of General and Community Pediatrics, Department of Pediatrics, and.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kahn
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000485:Allergens / Q000009:adverse effects; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010343:Patient Admission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012923:Social Class; D064890:Social Determinants of Health; D014481:United States
chemical_list: D000485:Allergens; D001993:Bronchodilator Agents
keywords: asthma; asthma exacerbation; childhood asthma; health disparities; intensive care unit