November 17, 2011 (Boston, Massachusetts) — Children with asthma who live in single-parent homes are 50% more likely to be readmitted to the hospital within 12 months for worsening asthma symptoms, compared with children who live in 2-parent homes, according to a study presented in a poster session here at the American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Scientific Meeting.
Lead author Terri Moncrief, MD, from Cincinnati Children's Hospital Medical Center, Ohio, told Medscape Medical News that she noticed that the same families were returning to the hospital again and again. "We began to think that all of our best efforts to create a good medication regimen and the other interventions that we came up with were not working," Dr. Moncrief said. "I would notice the feel in the room, the overwhelmed parent — most times a mom with multiple children plus this child with a chronic illness — and I began to wonder what it is in these homes that is a barrier to good asthma care and control."
Dr. Terri Moncrief
The study involved 601 children 1 to 16 years of age. In addition to assessing the marital status of the primary caregiver, the researchers looked at factors that might be implicated in poorer asthma control.
These included financial strain (annual household income below $60,000), psychological stress (a high score on the validated K6 mental health screen), the time that the caregiver had to give each child (indicated by a higher ratio of children to adults in the home), and mobility (how often the child was cared for outside of the home).
Slightly more than half (53%) of the children were black, and 61% were publicly insured or had no health insurance.
The researchers found that 39% of the children were either readmitted or returned to the emergency department for asthma within 12 months of their index admission.
Fifty-two percent of primary caregivers in this study were single parents. Their children were more likely to return to the hospital than the children of married parents (odds ratio, 1.5; 95% confidence interval, 1.0 to 2.1).
The study also found that children in homes with an annual income below $60,000 were more likely to be readmitted than children in homes with a higher income (44% vs 26%; P = .009), and that an increased ratio of children to adults in the home was associated with increased rates of readmission and revisits to the emergency department (P = .05).
After controlling for all factors, financial strain emerged as the most important in predicting hospital readmission. Psychological stress and mobility did not determine hospital readmission or revisits, Dr. Moncrief said.
"I think we are touching on something that is really important here. If we, as physicians, start asking about household routine and complexity on a day-to-day basis to see how this affects asthma care, we can come up with some family-centered treatment regimens," Dr. Moncrief said. "We need to take into account the family stressors because, clearly, they affect a child's care."
Commenting on this study, Gailen D. Marshall, Jr, MD, PhD, from the University of Texas–Houston Medical School, told Medscape Medical News that "there is a strong relationship between level of stress and adherence. Those things are related in the literature. The more you worry, the more you are anxious about things, the less likely you are to do the routine things that you need to do."
Dr. Marshall added: "In my academic practice, I have a high percentage of single-parent families. The stereotypical view of lower socioeconomic individuals is that compliance is an issue of choice — they don't care; they don't want to. But when you have a parent, and in my experience it's usually a mother, who is working 2 jobs and is very occupied with just trying to survive, to be able to do the monitoring of any child with due diligence is very difficult, so the conclusion of this study is not at all surprising."
John Oppenheimer, MD, from Cedar Knolls, New Jersey, and scientific chair of the ACAAI meeting, added that this study "emphasizes that we need to think about what is happening to our patients outside of the medical illness. It reinforces that we have to think about the patient's social situation."
Dr. Moncrief and Dr. Marshall have disclosed no relevant financial relationships. Dr. Oppenheimer reports financial relationships with AstraZeneca, GlaxoSmithKline, Merck, and Novartis.
American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Scientific Meeting: Abstract P49. Presented November 6, 2011.
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