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Child Opportunity Index and Changes in Pediatric Acute Care Utilization in the COVID-19 Pandemic
Cristin Q Fritz1, Eric W Fleegler2, Heidi DeSouza3
1Division of Pediatric Hospital Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Pediatric acute care use dropped during COVID-19. Children in low-opportunity neighborhoods experienced the largest decrease, reducing healthcare disparities.
Area of Science:
- Pediatric Health Services Research
- Public Health
- Health Equity
Background:
- The coronavirus disease 2019 (COVID-19) pandemic significantly impacted pediatric acute care utilization.
- Disparities in healthcare access and utilization existed prior to the pandemic.
Purpose of the Study:
- To investigate the association between neighborhood opportunity levels and changes in pediatric acute care utilization during the COVID-19 pandemic.
- To compare changes in emergency department (ED) encounters and hospital admissions during the pandemic against pre-pandemic levels.
Main Methods:
- An observational study utilizing administrative data from 41 US pediatric hospitals.
- Included children aged 0-17 with ED encounters between March 15, 2020, and March 14, 2021 (pandemic period).
- Analyzed ED encounters and observation/inpatient admissions by Child Opportunity Index (COI) quintile, comparing pandemic to prepandemic periods.
Main Results:
- Overall relative volume reduction in acute care was 46.8% during the pandemic.
- Children from very low COI neighborhoods experienced a disproportionately larger volume drop (51.1%) compared to those from very high COI neighborhoods (42.8%).
- Most clinical diagnosis groups showed greater relative volume reductions in the very low COI quintile.
Conclusions:
- Acute care utilization decreased most significantly among children residing in very low COI neighborhoods.
- These changes narrowed existing disparities in acute care utilization.
- Further research on patient perspectives is needed to fully understand these utilization shifts.
Background:
Pediatric acute care utilization decreased dramatically during the coronavirus disease 2019 (COVID-19) pandemic. This study examined the association between the Child Opportunity Index (COI), a multidimensional neighborhood measure of childhood opportunity, and changes in acute care utilization at US pediatric hospitals during the COVID-19 pandemic compared with the previous 3 years.
Methods:
This observational study used administrative data across 41 US-based pediatric hospitals. Children aged 0 to 17 years with emergency department (ED) encounters during the study period were included. The COVID-19 pandemic time period (March 15, 2020-March 14, 2021) was the primary exposure. The primary outcome was the relative volume drop in ED encounters and observation/inpatient admissions through the ED by COI quintile.
Results:
Of 12 138 750 encounters, 3 705 320 (30.5%) were among the very low COI quintile. Overall, there was a 46.8% relative volume reduction in the pandemic period compared with the prepandmic period. This drop in volume occurred disproportionately among the very low COI quintile (51.1%) compared with the very high COI quintile (42.8%). The majority of clinical diagnosis groups demonstrated larger relative volume drops among the very low COI quintile.
Conclusions:
Acute care utilization decreased the most among children from very low COI neighborhoods, narrowing previously described acute care utilization disparities. Additional study of patient perspectives on health care needs and access during this period is required to understand these changes.
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