Neighborhood Opportunity and Mental Health-Related Hospitalization Rates Among Children and Youths in 12 U.S. States

Using the Child Opportunity Index (COI) 3.0 and mental health-related hospitalization rates among children and youths, the authors examined whether hospitalization rates were significantly associated with neighborhood conditions.

In this cross-sectional, population-based study, the authors analyzed mental health-related hospitalizations among children and youths (5-24 years) from 12 U.S. states by using data from the 2021 State Inpatient Databases and U.S. Census. The exposure was ZIP code-level COI 3.0, with an outcome of mental health hospitalization incidence rate per 10,000 population. Mental health hospitalizations included a primary psychiatric diagnosis indexed in the DSM-5. Hospitalization rates were estimated overall, by state, and by 10 psychiatric diagnosis categories. Differences across COI quintiles were examined with negative binomial regression models.

Among 21,156,318 children and youths, 157,641 were hospitalized for mental health problems, corresponding to an incidence rate of 74.5 per 10,000 population. The hospitalization rate (per 10,000 children and youths) was highest in the very low-COI quintile (incidence rate=76.9, 95% CI=73.4-80.5) and lowest in the very high-COI quintile (incidence rate=67.3, 95% CI=64.8-69.9). Trends were consistent within psychiatric diagnosis categories, except for anxiety disorders, which showed a positive correlation between COI level and hospitalization rates. Hospitalization rates varied significantly among states (ranging from 34 to 135 per 10,000 youths, in Oregon and Kentucky, respectively).

Children and youths residing in lower-opportunity neighborhoods had higher mental health-related hospitalization rates, which varied by state and psychiatric diagnosis. Future research to understand the reasons for these variations across COI levels could inform programs to avoid mental health-related hospitalizations.