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Child Opportunity Index and Rehospitalization for Ambulatory Care Sensitive Conditions at US Children's Hospitals
Kavita Parikh1, Michelle A Lopez2, Matt Hall3
1Division of Hospital Medicine, Children's National Hospital, Washington, DC.
Insights
Children in low Child Opportunity Index (COI) neighborhoods face higher rates of rehospitalization for ambulatory care sensitive conditions (ACSC). Addressing social determinants of health is crucial for prevention.
Area of Science:
- Pediatric Health Outcomes
- Social Determinants of Health Research
- Healthcare Disparities
Background:
- The Child Opportunity Index (COI) assesses neighborhood factors impacting child health.
- Previous studies link lower COI to increased healthcare utilization.
- The association between COI and rehospitalization for ambulatory care sensitive conditions (ACSC) is not well understood.
Purpose of the Study:
- To determine the association between neighborhood Child Opportunity Index (COI) and pediatric rehospitalizations for ambulatory care sensitive conditions (ACSC).
Main Methods:
- A multicenter retrospective cohort study included over 184,000 children (ages 0-17) admitted for ACSC.
- Exposure was defined by the Child Opportunity Index (COI) of the child's neighborhood.
- Outcomes included any or two or more ACSC rehospitalizations within one year, analyzed using logistic regression.
Main Results:
- Children from very low COI neighborhoods accounted for 28.3% of ACSC hospitalizations, compared to 16.5% from very high COI neighborhoods.
- After risk adjustment, children from very low COI neighborhoods had significantly higher rates of ACSC rehospitalization (any: aOR 1.14; ≥2: aOR 1.51) compared to those from very high COI neighborhoods.
- Specifically, 18.7% of children from very low COI neighborhoods experienced any rehospitalization versus 13.5% from very high COI neighborhoods.
Conclusions:
- Lower neighborhood Child Opportunity Index (COI) is associated with increased risk of rehospitalization for pediatric ambulatory care sensitive conditions (ACSC).
- Findings highlight the impact of social determinants of health on child health outcomes and healthcare utilization.
- Further research is needed to guide hospital systems in addressing community-level social factors to prevent rehospitalizations.
Objective:
Child Opportunity Index (COI) measures neighborhood contextual factors (education, health and environment, social and economic) that may influence child health. Such factors have been associated with hospitalizations for ambulatory care sensitive conditions (ACSC). Lower COI has been associated with higher health care utilization, yet association with rehospitalization(s) for ACSC remains unknown. Our objective is to determine the association between COI and ACSC rehospitalizations.
Methods:
Multicenter retrospective cohort study of children ages 0 to 17 years with a hospital admission for ambulatory care sensitive conditions in 2017 or 2018. Exposure was COI. Outcome was rehospitalization within 1 year of index admission (analyzed as any or ≥2 rehospitalization) for ACSC. Logistic regression models adjusted for age, sex, severity, and complex and mental health conditions.
Results:
The study included 184 478 children. Of hospitalizations, 28.3% were by children from very low COI and 16.5% were by children from very high COI neighborhoods. In risk-adjusted models, ACSC rehospitalization was higher for children from very low COI than very high COI neighborhoods; any rehospitalization occurred for 18.7% from very low COI and 13.5% from very high COI neighborhoods (adjusted odds ratio 1.14 [1.05-1.23]), whereas ≥2 rehospitalization occurred for 4.8% from very low COI and 3.2% from very high COI neighborhoods (odds ratio 1.51 [1.29-1.75]).
Conclusions:
Children from neighborhoods with low COI had higher rehospitalizations for ACSCs. Further research is needed to understand how hospital systems can address social determinants of health in the communities they serve to prevent rehospitalizations.
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