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Childhood Opportunity Index and Outcomes Across the Care Continuum for Children With Asthma
Alexandra Byrne1, Matt Hall2, Jay Berry3
1Department of Medical Education, Division of Hospital Medicine, Nicklaus Children's Hospital, Florida International University, Herbert Wertheim College of Medicine, Miami, Florida.
Insights
Children with lower Childhood Opportunity Index (COI) scores hospitalized for asthma had more severe illness and higher readmission rates. Neighborhood factors significantly impact pediatric asthma outcomes and care disparities.
Area of Science:
- Pediatric Health Services Research
- Social Determinants of Health
- Environmental Health
Background:
- The Childhood Opportunity Index (COI) measures neighborhood features impacting child health.
- Asthma hospitalizations in children present opportunities to examine health disparities.
- Understanding the link between neighborhood context and asthma outcomes is crucial for targeted interventions.
Purpose of the Study:
- To investigate the association between the Childhood Opportunity Index (COI) and health outcomes in children hospitalized for asthma.
- To analyze COI's impact across the entire asthma care continuum: prehospitalization, during hospitalization, and posthospitalization.
Main Methods:
- Retrospective cohort study utilizing the Pediatric Health Information System database.
- Inclusion criteria: children aged 2-18 years hospitalized for asthma between May 2021 and April 2022.
- Outcomes assessed: illness severity, length of stay, cost, emergency department revisits, and rehospitalizations, analyzed against COI using generalized estimating equations.
Main Results:
- 37.6% of asthma hospitalizations involved children with very low COI.
- Children with very low/low COI experienced more critical/severe illness (56.4%) compared to high/very high COI (47.5%).
- Very low COI was associated with increased likelihood of ED revisits (OR 2.2) and rehospitalizations (OR 1.8) within 365 days, but not length of stay or cost.
Conclusions:
- Lower Childhood Opportunity Index (COI) is linked to more severe asthma illness and higher post-hospitalization healthcare utilization.
- While length of stay and cost were similar, disparities in readmissions highlight the need for interventions.
- Assessing outcomes across the care continuum is vital for identifying and addressing health inequities in pediatric asthma management.
Background:
The Childhood Opportunity Index (COI) is a multidimensional measure of neighborhood features associated with child health. Our objective was to determine if COI is associated with outcomes across the care continuum in children hospitalized for asthma.
Methods:
This is a retrospective cohort study using the Pediatric Health Information System database of hospitalized children with asthma aged 2 to 18 years from May 1 2021 to April 30, 2022. Main exposure was COI. Outcomes were categorized into 3 periods: prehospitalization (illness severity), during hospitalization (length of stay [LOS] and cost), and posthospitalization (emergency department [ED] revisits and rehospitalizations within 365 days). Multivariable relationships between COI and outcomes were assessed with generalized estimating equations, adjusting for illness severity and age, sex, and clustering data by hospital.
Results:
Of 19 119 asthma hospitalizations, 37.6% were for children with very low COI. Children with very low and low COI more often had critical or severe illness compared with children with high and very high COI (56.4% vs 47.5%, P < .001). COI was not associated with adjusted LOS (P = .1) or cost (P = .1). Children with very low vs very high COI were more likely to revisit the ED (odds ratio [OR], 2.2; 95% CI, 1.8-2.5) and be rehospitalized (OR, 1.8; 95% CI, 1.6-2.1) within 365 days.
Conclusion:
Children with lower COI hospitalized for asthma were more often critically ill and experienced more ED revisits and rehospitalizations than children with higher COI but had similar adjusted LOS and cost. Evaluating outcomes across the care continuum, including before, during, and during hospitalization, rather than a single point in time may help identify disparities and develop targeted interventions.
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