Neighborhood Socioeconomic Deprivation and Length of Stay in Children With Medical Complexity

Children with medical complexity (CMC) often experience long hospital length of stay (LOS). Many families of CMC experience financial and social hardships, which impact arrangement of the home supports necessary for discharge. Understanding neighborhood context in which CMC live is one way to examine the effects of these hardships on LOS. We aimed to evaluate the association between neighborhood socioeconomic deprivation and hospital LOS in CMC.

We conducted a single-center retrospective study including hospitalized children aged up to 21 years with 2 or more complex chronic conditions discharged from hospital medicine in 2016 to 2022. We excluded neonatal intensive care hospitalizations. We mapped home addresses to US census-tract data to calculate the primary exposure, the Brokamp neighborhood socioeconomic deprivation index. We used linear mixed models to examine the association between deprivation index and LOS (continuous days), adjusting for covariates (eg, patient clinical characteristics) and accounting for within patient clustering.

We included 4697 encounters from 2186 CMC. The median deprivation index was 0.33 (IQR, 0.25-0.42) and median LOS was 3.29 days (IQR, 1.86-6.91). In adjusted analysis, for each 0.1 increase in deprivation index, LOS increased 1.05-fold (95% CI, 1.03-1.08). Therefore, we expect a 9% increase in LOS for CMC living in more socioeconomically deprived neighborhoods (our cohort's 75th percentile deprivation index: 0.42) vs less deprived neighborhoods (our cohort's 25th percentile deprivation index: 0.25).

CMC from neighborhoods with greater socioeconomic deprivation experienced longer hospitalizations even when accounting for level of complexity and severity of illness. While the clinical effect is small individually, our results highlight systemic inequities.