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Published on: August 7, 2017

The Child Opportunity Index as a Moderator of the Effectiveness of Multi-Modal Evidence-Based Asthma Care

Jordan Tyris1, Diane L Putnick2, Shilpa J Patel1

  • 1Department of Pediatrics, Children's National Hospital and the George Washington School of Medicine and Health Sciences (J Tyris, SJ Patel, and K Parikh), Washington, DC.

Academic Pediatrics
|June 28, 2026
PubMed

Insights

An evidence-based asthma intervention reduced emergency department visits for children. However, this benefit was less pronounced for children in lower Child Opportunity Index (COI) areas, highlighting the need for tailored approaches to achieve health equity.

Area of Science:

  • Pediatric Asthma Management
  • Health Equity Research
  • Social Determinants of Health

Background:

  • Asthma is a leading cause of pediatric emergency department (ED) visits.
  • Socioeconomic factors, such as those captured by the Child Opportunity Index (COI), can influence health outcomes.
  • The effectiveness of asthma interventions may vary across different socioeconomic strata.

Purpose of the Study:

  • To determine if the Child Opportunity Index (COI) moderates the association between a multimodal asthma intervention and asthma-related ED reutilization in children.
  • To investigate disparities in the effectiveness of evidence-based asthma care based on neighborhood opportunity levels.

Main Methods:

  • A prospective cohort of children under 16 with prior asthma-related ED visits was analyzed.
  • Associations between a multimodal evidence-based asthma intervention and ED reutilization within one year were evaluated using survival analysis.
  • Interactions between the Child Opportunity Index (COI) and intervention effectiveness were tested by stratifying based on dichotomized COI levels (lower vs. higher).

Main Results:

  • The asthma intervention was associated with a reduced risk of ED reutilization overall (aHR 0.58).
  • This protective effect was significantly diminished for children aged 5-11 residing in lower COI areas compared to higher COI areas (p-interaction=0.01).
  • No significant moderation by COI was observed in other age groups.

Conclusions:

  • The effectiveness of evidence-based asthma interventions may be reduced in areas with lower socioeconomic opportunity.
  • Tailoring interventions to address COI-related barriers is crucial for achieving equitable asthma-related health outcomes.
  • Community partnerships are essential to address the root causes of socioeconomic disparities and improve child health.
Abstract

Keywords:
pediatric asthma morbidityplacesocial adversitysocial determinants of health

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