Impact of Social Determinants of Health on Health Care Utilization in Pediatric Appendicitis

Limited data exist on the role neighborhood-level social determinants of health (SDOH) play in health care utilization in pediatric patients with common, nonelective surgical conditions. We aimed to test the hypothesis that lower neighborhood-level SDOH are associated with increased health care utilization in pediatric acute uncomplicated appendicitis (AUA) before and during the COVID-19 pandemic.

This retrospective cohort study included patients aged younger than 19 years, hospitalized through emergency departments, and diagnosed with AUA. Discharge data from January 1, 2017, through February 28, 2022, were obtained from 28 hospitals in the Pediatric Health Information System database. Childhood Opportunity Index (COI) was used as an estimate of neighborhood-level SDOH. Logistic regression with generalized estimating equations assessed for association of COI level with prolonged length of stay (PLOS, defined as ≥2 SD above mean LOS) and/or a related 30-day return visit.

We identified 37 670 children with AUA. We found that 2678 (7.1%) had PLOS, 1340 (3.6%) had related 30-day return visits, and 241 (0.6%) had both outcomes. After adjusting for sex, age, overweight/obesity, and pre-/intra-COVID-19 pandemic time frames, children with very low COI levels were 70% more likely to have PLOS (adjusted odds ratio [aOR], 1.70; CI, 1.2-2.37), 27% more likely to have related 30-day return visits (aOR, 1.27; CI, 1.04-1.53), and 64% more likely to have both (aOR, 1.64; CI, 1.11-2.44) compared with those with a very high COI level.

In pediatric patients presenting with AUA, a very low COI level was associated with increased health care utilization. Further research is needed to identify contributing factors and develop strategies to mitigate disparities.