Association Between the COI and Excess Health Care Utilization and Costs for ACSC

Area of Science:

• Pediatric Health
• Health Services Research
• Social Determinants of Health

Background:

• Previous research linked the Childhood Opportunity Index (COI) to higher rates of ambulatory care sensitive conditions (ACSC) hospitalizations.
• The financial and resource burden of this health inequity on the healthcare system remains largely unquantified.

Purpose of the Study:

• To quantify the excess healthcare resource utilization and costs associated with lower neighborhood opportunity.
• To analyze excess hospitalizations, hospital days, and financial expenditures related to ACSC in children across different COI strata.

Main Methods:

• Retrospective cross-sectional study utilizing the Pediatric Health Information Systems database (2016-2022).
• Inclusion of inpatient hospitalizations for children under 18 years.
• Comparison of ACSC hospitalizations, mortality, and costs stratified by COI levels.

Main Results:

• Over 2.8 million hospitalizations were analyzed, with 44.5% for ACSCs.
• Children in the very low COI stratum had a higher proportion of potentially preventable ACSC hospitalizations (49.1%) compared to the very high COI stratum (39.7%).
• Lower COI was associated with increased odds of preventable hospitalizations (OR 1.18). Excess hospitalizations amounted to $1.3 billion, with 813 excess deaths, predominantly in the lowest COI strata.

Conclusions:

• Children residing in neighborhoods with lower opportunity face a greater risk of ACSC hospitalizations.
• The Childhood Opportunity Index can identify communities where targeted interventions may effectively reduce healthcare utilization and associated costs.
• Addressing social determinants of health through initiatives focused on neighborhood opportunity is crucial for mitigating pediatric health disparities and healthcare expenditures.