Place-Based Opportunity and Well Child Visit Attendance in Early Childhood
Jordan Tyris1, Diane L Putnick2, Kavita Parikh3
1Division of Hospital Medicine, Children's National Hospital (J Tyris and K Parikh), Washington, DC; Department of Pediatrics, George Washington University School of Medicine and Health Sciences (J Tyris and K Parikh), Washington, DC; Epidemiology Branch (J Tyris, DL Putnick, and EH Yeung), Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md.
Insights
Children in lower opportunity neighborhoods attend fewer well-child visits. Addressing healthcare access barriers for these children is crucial for equitable early childhood care.
Area of Science:
- Pediatric Health
- Social Determinants of Health
- Health Equity
Background:
- Lower neighborhood opportunity, measured by the Child Opportunity Index (COI), is linked to increased pediatric morbidity.
- The association between COI and longitudinal well-child care attendance is less understood.
- This study investigates the relationship between COI and well-child visit (WCV) attendance from birth to under 36 months.
Purpose of the Study:
- To evaluate the association between the Child Opportunity Index (COI) and well-child visit (WCV) attendance in early childhood.
- To determine if neighborhood opportunity influences adherence to recommended pediatric preventive care schedules.
- To identify potential disparities in healthcare access based on socioeconomic factors measured by COI.
Main Methods:
- Utilized the Upstate KIDS population-based birth cohort (children born 2008-2010 in New York).
- Linked child's birth address to 2010 census tract Child Opportunity Index (COI) scores (Very Low to Very High).
- Collected WCV attendance data via parental questionnaires every 4-6 months, assessing visits from birth to <36 months.
Main Results:
- Children in Very Low (aOR 0.68) and Low (aOR 0.81) COI neighborhoods had significantly decreased odds of attending any WCV compared to Very High COI.
- Adjusted mean proportions of WCV attendance were lower across Very Low (0.45), Low (0.53), Moderate (0.53), and High (0.54) COI levels versus Very High (0.56).
- 21% of the cohort experienced Very Low or Low COI, highlighting a substantial population affected by lower opportunity.
Conclusions:
- Lower neighborhood opportunity at birth is significantly associated with reduced well-child visit attendance in early childhood.
- Findings suggest that socioeconomic factors influence access to and utilization of essential pediatric preventive care.
- Interventions aimed at reducing healthcare access barriers for children in lower COI areas are needed to promote health equity.
Background:
Lower neighborhood opportunity, measured by the Child Opportunity Index [COI], is associated with increased pediatric morbidity, but is less frequently used to examine longitudinal well child care. We aimed to evaluate associations between the COI and well child visit [WCV] attendance from birth - <36 months of age.
Methods:
The Upstate KIDS population-based birth cohort includes children born 2008-2010 in New York state. The exposure, 2010 census tract COI (very low [VL] to very high [VH]), was linked to children's geocoded residential address at birth. The outcome was attended WCVs from birth - <36 months of age. Parents reported WCVs and their child's corresponding age on questionnaires every 4-6 months. These data were applied to appropriate age ranges for recommended WCVs to determine attendance. Associations were modeled longitudinally as odds of attending visits and as mean differences in proportions of WCVs by COI.
Results:
Among 4650 children, 21% (n = 977) experienced VL or low COI. Children experiencing VL (adjusted OR [aOR] 0.68, 95% CI 0.61, 0.76), low (aOR 0.81, 95% CI 0.73, 0.90), and moderate COI (aOR 0.88, 95% CI 0.81, 0.96), compared to VH COI, had decreased odds of attending any WCV. The estimated, adjusted mean proportions of WCV attendance were lower among children experiencing VL (0.45, P < .01), low (0.53, P = .02), moderate (0.53, P = .05), and high (0.54, P = .03) compared to VH COI (0.56).
Conclusions:
Lower COI at birth was associated with decreased WCV attendance throughout early childhood. Reducing barriers to health care access for children experiencing lower COI may advance equitable well child care.
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