315 - Associations between Health-related Social Needs and 365-day readmission among urban children hospitalized for asthma.

Publication Number: 2304.315

Florinda Islamovic, The Children's Hospital at Montefiore, Bronx, NY, United States; Jonathan M. Gabbay, The Children's Hospital at Montefiore, White Plains, NY, United States; Samantha R. Levano, Albert Einstein College of Medicine, BRONX, NY, United States; Hemen Muleta, Albert Einstein College of Medicine, Bronx, NY, United States; Michelle Shankar, Children's Hospital at Montefiore Einstein, New York, NY, United States; Marina Reznik, The Children's Hospital at Montefiore, Bronx, NY, United States; Kevin Fiori, The Children's Hospital at Montefiore, Bronx, NY, United States

Background: Asthma is a leading cause of pediatric hospitalizations. Unmet health-related social needs (HRSNs), such as housing quality or housing insecurity, contribute to higher asthma morbidity and higher healthcare utilization, yet little is known about whether HRSNs differ for children who are readmitted compared to those who are not. Understanding these differences and the association of HRSNs with readmission status could guide discharge planning and care coordination efforts.

Objective: To compare HRSNs by readmission status and assess their association with 365-day readmission among children hospitalized for asthma exacerbation at an urban tertiary children's hospital.

Design/Methods: We conducted a retrospective cohort study of patients ≥4 years old admitted with an asthma exacerbation from November 2023 to May 2025. Clinical and demographic data were obtained from the Pediatric Health Information System and merged with HRSNs screening data from the institution's electronic health record using unique patient identifiers. The primary outcome was readmission within 365 days of index visit. We conducted descriptive statistics using Wilcoxon rank sum, chi-square and ANOVA tests. We used logistic regression to examine associations between ever reporting ≥1 HRSNs and readmission adjusting for age, sex, race/ethnicity, language, insurance, ≥1 complex chronic conditions (CCCs), and Diagnosis Related Group severity.

Results: Our cohort included 764 patients with a median age 7 years (IQR [5,11]), who were predominately male (57.3%), Hispanic (51.4%), and government insured (80.9%) (Table 1). Of 764 patients, 123 (16.1%) were readmitted within 365 days. Compared to children with one admission, readmitted children were more often female, Hispanic, publicly insured, and had CCCs (p < 0.05) (Table 1). In bivariate analyses, readmission was significantly associated with ≥1 HRSN and with specific needs related to food, housing, child/adult care, legal, transportation and utilities (Table 1) (p < 0.05). Children with ≥1 HRSN had 1.66 times greater odds of readmission compared to children with no HRSNs (aOR 1.66, 95% CI 1.07, 2.54) (Table 2).

Conclusion(s): Among urban children hospitalized for asthma, readmitted children with asthma had higher prevalence and a greater burden of HRSNs. Additionally, those with HRSNs had significantly higher odds of 365-day readmission compared to children without HRSNs,. This underscored the importance of systematic HRSN screening and potential for tailored social care interventions to prevent rehospitalizations.

Table 1: Demographics and HRSNs Among Readmitted vs. Non-Readmitted Children (1)
(1) n(%), unless otherwise stated. Children with neurologic, hematologic or procedural All Patient Refined Diagnosis-Related Groups (APR-DRG) codes ( <1%) or those with <2 visits and reside outside New York State were excluded ( <1%).
(2)
Social needs are self-reported on screening tool provided to caregivers and described here as ever reported a HRSN on any encounter.

Table 2: Logistic Regression Assessing the Association of Health-Related Social Needs and Clinical Factors With 365-Day Readmission (1)
(1)There were a total of 577 unique patients included in this logistic regression model.
(2 )White/Asian/Multiracial and Other race were merged due to low cell counts
Abbreviations: CI: Confidence Interval; ref: reference group; HRSN: Health Related Social Needs DRG: Diagnosis Related Group

Figure 1: Health System Adapted Health-Related Social Needs Screening Tool