Association of the Child Opportunity Index on Severity of Pediatric Asthma Exacerbation Admissions

Asthma is one of the most common chronic childhood diseases and reason for hospital admission. Previous studies using Childhood Opportunity Index (COI), a 5-level scale assessing neighborhood opportunity, have demonstrated mixed associations with asthma admissions and less often considered a child's initial presentation to a children's hospital.

Among children presenting to the emergency department (ED), explore the association of COI with asthma admission and admission severity.

This was a retrospective study using the Pediatric Health Information System database including patients aged 2 to 18 years presenting to the ED for asthma exacerbations from May 1, 2022, to December 31, 2023. Main exposure was COI. The primary outcome was hospital admission, accounting for escalation in care: moderate (acute care), severe (intensive care unit [ICU]), and very severe (mechanical ventilation). A multilevel model accounted for clustering by hospital and patient characteristics.

Of 122 556 ED asthma visits, 72% were discharged. Most were male (61%), non-Hispanic Black (38%), and government insured (65%). Among admissions, 87% had moderate severity, 13% were severe, and 0.1% were very severe. Children with low COI represented the majority of ED visits (51%). Children with lower COI were less likely to be admitted (very low vs very high COI; odds ratio [OR], 0.81; 95% CI, 0.77-0.84) and more likely to require ICU care (low vs very high COI; OR, 1.15; 95% CI, 1.02-1.30).

Children with lower COI often presented to the ED with lower odds of admission but increased odds of severe admission. When considering COI, investigators should ensure focus on both access to care and risk of severe illness.