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Published on: January 12, 2019
Unpacking Social Disadvantage Metrics in Neuromuscular Conditions: Area Deprivation Index Versus Child Opportunity
Sam P Wimmer1, Tishya A L Wren1,2, Susan A Rethlefsen1
1Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Insights
Social determinants of health (SDOH) impact children with neuromuscular disorders. The Area Deprivation Index (ADI) and Child Opportunity Index (COI) assess SDOH differently, suggesting multiple indices are needed for comprehensive evaluation.
Area of Science:
- Pediatric Health
- Social Determinants of Health
- Health Services Research
Background:
- Social determinants of health (SDOH) significantly influence healthcare access and outcomes for children, particularly those with neuromuscular disorders (NMD).
- Understanding the nuances of SDOH is crucial for improving care for vulnerable pediatric populations.
- Existing indices for measuring SDOH may offer different perspectives.
Purpose of the Study:
- To compare the evaluations of SDOH provided by the Area Deprivation Index (ADI) and the Child Opportunity Index (COI) in children with NMD.
- To determine the congruence and discrepancies between ADI and COI in assessing the socioeconomic environment of children with NMD.
Main Methods:
- A retrospective cohort study analyzed data from 463 children with NMD treated at a tertiary children's hospital.
- The Child Opportunity Index (COI) was calculated using ZIP codes, encompassing education, health, environment, and socioeconomic domains.
- The Area Deprivation Index (ADI) was based on census blocks, measuring income, education, employment, and housing quality. Statistical analyses included correlations, t-tests, ANOVAs, and regressions.
Main Results:
- A significant negative correlation was found between ADI and COI (r = -0.71, P < .001), indicating related but distinct measures.
- ADI scores varied considerably within COI quintiles, highlighting differences in assessment.
- Disparities in ADI and COI were observed based on insurance status and race/ethnicity, with no significant differences based on sex or NMD diagnosis for COI.
Conclusions:
- The Area Deprivation Index (ADI) and Child Opportunity Index (COI) assess social determinants of health (SDOH) in distinct ways, despite being correlated.
- Utilizing multiple SDOH indices may provide a more comprehensive understanding of their impact on healthcare access and outcomes for children with NMD.
- Further research is needed to refine the application of SDOH indices in pediatric healthcare.
Background And Objectives:
Social determinants of health (SDOH) impact healthcare access and outcomes for children, including those with neuromuscular disorders (NMD). This study examines the extent to which the Area Deprivation Index (ADI) and Child Opportunity Index (COI) provide similar evaluations of SDOH in children with NMD.
Methods:
463 children with NMD <18 years treated at a tertiary children's hospital met inclusion criteria. COI, calculated using ZIP codes, includes education, health and environment, and social and economic domains. ADI, based on census block, measures income, education, employment, and housing quality. Lower COI and higher ADI are thought to represent more adverse SDOH. Analyses included Pearson's correlations, t-tests, ANOVAs, and multivariable regressions.
Results:
ADI and COI were negatively correlated (r = -0.71, P < .001). Furthermore, similar correlations were observed across COI's three subdomains: education (r = -0.71), social and economic (r = -0.67), and health and environment (r = -0.68) (all P < .001). However, ADI scores varied greatly within each COI quintile. ADI was lower and COI was higher for patients with private versus public insurance (P < .001) and for White and Asian versus Black and Hispanic children (P < .001). While COI did not differ among diagnoses (P = .73), ADI was higher for children with myelomeningocele (P = .003) and cerebral palsy (P = .03) compared with those with Charcot-Marie-Tooth disease. Lastly, there was no difference in ADI (P = .44) or COI (P = .71) based on sex.
Conclusions:
While ADI and COI are related, they assess SDOH differently. Using multiple SDOH indices may better capture SDOH's impacts on healthcare access and outcomes.
Key Concepts:
(1)The health of children with neuromuscular conditions is affected by social determinants of health.(2)Lower levels of social determinants of health have been shown to delay access to care and negatively impact children's health.(3)The Area Deprivation Index and Child Opportunity Index are two indices often used to quantify social determinants of health and have not yet been directly compared to evaluate their congruence.(4)This study identifies and explores gaps between these two measurements so that clinicians and researchers can more accurately evaluate the impacts of social determinants of health on children's health.
Levels Of Evidence:
Level III as this is a retrospective cohort study.
