Neighborhood Child Opportunity Index and Household-Level Social Needs

Area of Science:

• Health Services Research
• Social Determinants of Health
• Health Equity

Background:

• Hospitals are mandated to screen for health-related social needs (HRSNs).
• Neighborhood indices, such as the Child Opportunity Index (COI), may help identify at-risk families.
• The predictive accuracy of neighborhood-level COI for household-level HRSNs is not well understood.

Purpose of the Study:

• To evaluate the association between neighborhood-level Child Opportunity Index (COI) and the prevalence of household-level health-related social needs (HRSNs).
• To assess the utility of COI as a proxy for identifying families requiring HRSN screening and support.

Main Methods:

• Cross-sectional study of 1096 pediatric hospital patients.
• Combined standardized household-level HRSN screening data with patient neighborhood COI data.
• Used logistic regression to analyze the odds of HRSNs based on COI quintiles and calculated predictive values.

Main Results:

• Lower COI quintiles were associated with significantly higher odds of reporting household HRSNs (OR 2.62).
• COI demonstrated low positive predictive value (3-31%) but high negative predictive value (91-99%) for most HRSNs.
• No significant difference in resource connection rates was observed across COI strata.

Conclusions:

• While families in disadvantaged neighborhoods report more HRSNs, COI is an unreliable proxy for individual household screening.
• Health systems can leverage COI to prioritize community-level screening and resource allocation for HRSNs.
• Direct household screening remains crucial for accurate identification and support for families experiencing HRSNs.