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Association Between Neighborhood Disadvantage and Pediatric Readmissions
Carrie L Nacht1, Michelle M Kelly1, M Bruce Edmonson1
1Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, H4/410 CSC, Madison, WI, 53792, USA.
Insights
Children in neighborhoods with high socioeconomic disadvantage have a greater risk of 30-day readmission. Addressing neighborhood factors is crucial for preventing pediatric readmissions.
Area of Science:
- Pediatric Health Outcomes
- Social Determinants of Health
- Health Services Research
Background:
- Individual social determinants of health (SDH) impact readmission risk.
- Contextual-level SDH, like neighborhood disadvantage, are less understood in pediatric readmissions.
Purpose of the Study:
- To examine the association between neighborhood disadvantage, measured by the Area Deprivation Index (ADI), and 30-day readmission rates in children.
- To identify neighborhood-level factors influencing pediatric readmission risk.
Main Methods:
- Retrospective cohort study using Maryland's 2013-2016 all-payer dataset for patients under 20.
- Area Deprivation Index (ADI) quantified neighborhood socioeconomic disadvantage.
- Generalized estimating equations adjusted for patient demographics, clinical severity (CCI, PMCA, APR-DRG), and hospital volume.
Main Results:
- The overall pediatric readmission rate was 4.0% among 138,998 discharges.
- Children in the most disadvantaged neighborhoods (highest ADI quartile) had significantly higher odds of readmission (aOR 1.19).
- Readmissions were also associated with public insurance and indicators of medical complexity.
Conclusions:
- Neighborhood socioeconomic disadvantage independently predicts pediatric 30-day readmissions.
- While medical complexity is a stronger predictor, neighborhood disadvantage is a modifiable factor for intervention.
- Findings highlight the importance of considering neighborhood context in pediatric readmission prevention and risk stratification.
Objective:
Although individual-level social determinants of health (SDH) are known to influence 30-day readmission risk, contextual-level associations with readmission are poorly understood among children. This study explores associations between neighborhood disadvantage measured by Area Deprivation Index (ADI) and pediatric 30-day readmissions.
Methods:
This retrospective cohort study included discharges of patients aged < 20 years from Maryland's 2013-2016 all-payer dataset. The ADI, which quantifies 17 indicators of neighborhood socioeconomic disadvantage within census block groups, is used as a proxy for contextual-level SDH. Readmissions were identified with the 30-day Pediatric All-Condition Readmissions measure. Associations between ADI and readmission were identified with generalized estimating equations adjusted for patient demographics and clinical severity (Chronic Condition Indicator [CCI], Pediatric Medical Complexity Algorithm [PMCA], Index Hospital All Patients Refined Diagnosis Related Groups [APR-DRG]), and hospital discharge volume.
Results:
Discharges (n = 138,998) were mostly female (52.7%), publicly insured (55.1%), urban-dwelling (93.0%), with low clinical severity levels (0-1 CCIs [82.3%], minor APR-DRG severity [48.4%]). Overall readmission rate was 4.0%. Compared to the least disadvantaged ADI quartile, readmissions for the most disadvantaged quartile were significantly more likely (aOR 1.19, 95% CI 1.09-1.30). After adjustment, readmissions were associated with public insurance and indicators of medical complexity (higher number of CCIs, complex-chronic disease PMCA, and APR-DRG severity).
Conclusion:
In this all-payer, statewide sample, living in the most socioeconomically disadvantaged neighborhoods independently predicted pediatric readmission. While the relative magnitude of neighborhood disadvantage was modest compared to medical complexity, disadvantage is modifiable and thus represents an important consideration for prevention and risk stratification efforts.
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