Association of social determinants of health and asthma control among children aged 5-18 years old in Metro Manila, Philippines

Asthma is the most prevalent chronic disease among the pediatric population in low-income to middle-income countries. The Philippines is an example of a low-middle income country wherein social determinants of health play a significant role in asthma control. The study aims to determine if there is a significant relationship between social determinants of health and asthma control among known asthmatic children aged 5-18 years old in Metro Manila. A cross-sectional study was conducted in Metro Manila, Philippines from June to August 2025. Convenience sampling was done to gather data from caregivers of asthmatic children. Information on demographics, social determinants, and asthma control were collected through a self-administered questionnaire. Associations with asthma control were analyzed using chi-square, Mann-Whitney, t-tests, and logistic regression. Statistical significance was set at p < 0.05. Higher caregiver education, caregiver employment, household income, annual health expenditure, and health insurance were significantly associated with better asthma control (ORs ranging from 0.22–2.21, p < 0.05). Children exposed to second-hand smoke were more than twice as likely to have activity limitations (OR 2.51, 95% CI 1.19–5.28). This study provides evidence that children from a higher socioeconomic status achieved higher levels of asthma control and are associated with fewer ER visits and hospitalizations.哮喘是中低收入国家儿童群体中最普遍的慢性疾病。菲律宾作为中低收入国家的典型代表，其健康的社会决定因素（social determinants of health）对哮喘控制效果具有显著影响。本研究旨在探究菲律宾马尼拉大都会区5至18岁确诊哮喘儿童中，健康的社会决定因素与哮喘控制水平之间是否存在显著关联。本研究于2025年6月至8月在菲律宾马尼拉大都会区开展横断面研究（cross-sectional study），采用便利抽样法（convenience sampling）收集哮喘儿童照料者的相关数据。通过自填式问卷收集人口统计学特征、健康的社会决定因素及哮喘控制相关信息。采用卡方检验（chi-square）、曼-惠特尼U检验（Mann-Whitney）、t检验及逻辑回归（logistic regression）分析与哮喘控制相关的影响因素，设定统计学显著性阈值为p<0.05。研究结果显示，照料者受教育程度更高、照料者拥有稳定就业、家庭收入更高、年度医疗支出更多且持有健康保险的儿童，其哮喘控制水平显著更佳（比值比（Odds Ratio，OR）区间为0.22~2.21，p<0.05）。暴露于二手烟（second-hand smoke）的儿童出现活动受限的概率是未暴露儿童的两倍以上（OR=2.51，95%置信区间（Confidence Interval，CI）：1.19~5.28）。本研究证实，社会经济地位较高的儿童哮喘控制水平更佳，且急诊就诊（ER）与住院次数更少。