Clustering of self-reported social and environmental risk factors identifies vulnerable subgroups with increased asthma morbidity
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Social determinants of health (SDOH) and environmental triggers contribute to risk of asthma exacerbations. Electronic health record (EHR) data rarely capture complete SDOH and asthma trigger information, thereby limiting comprehensive risk factor assessments absent additional data sources. Objective We collected detailed SDOH and trigger data from patients with asthma who were identified from EHRs to better understand modifiable risk factors contributing to risk of asthma emergency department (ED) visits. Methods We invited patients with asthma identified through the Penn Medicine EHR to complete an online questionnaire covering SDOH, asthma triggers, and asthma history. Zero-inflated Poisson regression models were fit to identify factors associated with ED visits for asthma, and hierarchical agglomerative clustering was used to explore underlying patterns in the data. Results Among 974 survey respondents, 206 reported one or more asthma-related ED visit in the last year. Nearly all SDOH and asthma trigger variables were significantly associated with asthma ED visits in univariable models, but most of these effects were strongly attenuated in multivariable regression models. The effect of race, however, remained strong in both models. Post hoc analyses showed that additionally adjusting for SDOH variables attenuated the relationships between asthma triggers and ED visits. Cluster analysis revealed that the subgroup of participants reporting highest social vulnerability and most asthma triggers also had the most asthma-related ED visits, hospitalizations, and days missed of work or school (all p < 10 -4 ). Conclusion Our results demonstrate that self-reported SDOH and asthma trigger data are useful to identify subpopulations at highest risk for adverse asthma outcomes.
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,000
Awards: Clinic navigation and home visits to improve guideline-based care and outcomes in low income minority adults with asthma, Center of Excellence in Environmental Toxicology, Building equitable and feasible clinical decision support tools for population health management of people living with chronic lung disease, Precision Approaches to Reduce Asthma Disparities with Electronic Health Record Data
OpenAlex ID: W7203460626