Comparing Social Disadvantage Indices in Pediatric Populations

Place-based social disadvantage indices are increasingly used to promote health equity, but vary in design. We compared associations between 3 commonly used indices (Social Vulnerability Index [SVI], Area Deprivation Index [ADI], and Child Opportunity Index [COI]) and infant well-child check (WCC) attendance and adolescent obesity. We hypothesized that the COI would have the strongest association with child health outcomes.

We conducted a cross-sectional analysis of 2014-2019 Duke University Health System electronic health record data. Eligible participants were ≤18 years old, had outpatient encounters during the study period, and resided in Durham County, North Carolina. We aggregated indices into deciles; higher deciles represented greater disadvantage. Multivariable logistic regression models quantified the association between each index and infant WCC attendance (ages 0-15 months) and adolescent obesity (11-17 years).

There were 10 175 and 14 961 children in the WCC and obesity cohorts, respectively. All 3 indices were similarly associated with WCCs (SVI odds ratio [OR] 1.10, 95% confidence interval [CI] 1.08-1.12; ADI OR 1.10, 95% CI 1.08-1.12; COI OR 1.12, 95% CI 1.10-1.14) and obesity (SVI OR 1.06, 95% CI 1.04-1.07; ADI OR 1.08, 95% CI 1.06-1.10; COI OR 1.07, 95% CI 1.05-1.08). ORs indicate the increase in the outcome odds for every 1-decile index score increase.

Higher disadvantage as defined by all 3 indices was similarly associated with adolescent obesity and decreased infant WCC attendance. The SVI, ADI, and COI may be equally suitable for pediatric research, but population and outcome characteristics should be considered when selecting an index.