Pediatric asthma population risk stratification using k-means clustering.

IF 1.3 4区 医学 Q3 ALLERGY
Mandana Rezaeiahari, Arina Eyimina, Melanie Boyd, Clare C Brown, Tamara T Perry, Erhan Ararat, J Mick Tilford, Akilah A Jefferson
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引用次数: 0

Abstract

Objectives: Incorporating social determinants of health to identify distinct pediatric asthma patient groups can help stratify populations by their risk of adverse events, improving targeted outreach and care.

Methods: Insurance claims and enrollment data from the Arkansas All-Payer Claims Database identified 22 169 children aged 5-18 years with an asthma diagnosis in 2018 and continuous Medicaid enrollment in 2018 and 2019. The clustering approach used information on comorbid conditions, asthma controller medication intensity, total controller and reliever medications filled, zip code-level Child Opportunity Index, and rural-urban classification. Binary and categorical variables were first transformed into continuous latent variables using Generalized Low-Rank Models. K-means clustering with Euclidean distance was then applied. The resulting clusters were compared based on asthma-related emergency department (ED) visits and hospitalizations in 2018.

Results: K-means clustering identified six clusters. The distribution of ED visits differed significantly across the clusters (p < 0.001) with Cluster 1 having the highest observed percentages (1 ED visit: 9.5%; ≥2 ED visits: 2.6%). This cluster consisted of 65.9% Black and had the highest proportion of children residing in neighborhoods with very low child opportunity scores: 90.5% had very low education scores, 85.5% very low health and environment scores, and 94.4% very low social and economic scores.

Conclusions: Interventions to reduce pediatric asthma disparities should address social, economic, and environmental inequities. Clustering identified children from low child opportunity areas in Arkansas, with a high percentage of Black children, as a high-risk group for asthma exacerbations, underscoring the potential of population risk stratification for tailoring interventions.

使用k-均值聚类的儿童哮喘人群风险分层。
目的:纳入健康的社会决定因素,以确定不同的儿科哮喘患者群体,可以帮助根据不良事件的风险对人群进行分层,改善有针对性的推广和护理。方法:来自阿肯色州全付款人索赔数据库的保险索赔和登记数据确定了2018年诊断为哮喘的22 169名5-18岁儿童,并在2018年和2019年连续参加了医疗补助计划。聚类方法使用了合并症、哮喘控制者用药强度、控制者和缓解者用药总量、邮政编码水平的儿童机会指数和城乡分类等信息。首先利用广义低秩模型将二元变量和分类变量转化为连续潜变量。然后应用欧氏距离的K-means聚类。根据2018年哮喘相关急诊科(ED)就诊和住院情况对所得聚类进行比较。结果:K-means聚类识别出6个聚类。急诊科就诊分布在不同组间差异显著(p)。结论:减少儿童哮喘差异的干预措施应解决社会、经济和环境不平等问题。聚类发现,来自阿肯色州儿童机会低地区的儿童(黑人儿童比例很高)是哮喘恶化的高风险群体,强调了人口风险分层以定制干预措施的潜力。
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来源期刊
Journal of Asthma
Journal of Asthma 医学-过敏
CiteScore
4.00
自引率
5.30%
发文量
158
审稿时长
3-8 weeks
期刊介绍: Providing an authoritative open forum on asthma and related conditions, Journal of Asthma publishes clinical research around such topics as asthma management, critical and long-term care, preventative measures, environmental counselling, and patient education.
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