Association between the childhood opportunity index and healthcare utilization in cystic fibrosis

Among people with cystic fibrosis (CF), limited data exists describing how area-level socioeconomic factors influence in-hospital, emergency room, and ambulatory surgery healthcare utilization. Using the Childhood Opportunity Index (COI) as an area-level composite measure, we aimed to describe the healthcare utilization patterns among children with CF (CwCF) by COI and determine if COI is associated with increased healthcare utilization.

Retrospective cohort study that utilized the CF Foundation Patient Registry-Pediatric Health Information System dataset. The COI version 3.0 was used. Primary study outcomes included the number of hospital encounters (hospitalizations, emergency room visits, and ambulatory surgeries) between 2009-2022, compared among five COI quintiles. Generalized estimating equations were used to regress hospital encounter on COI quintile with a Poisson distribution and clustered on hospital.

8177 CwCF <22 years contributed 65,038 hospital encounters for analysis. Compared to the very high quintile, CwCF in the very low, low, and moderate quintiles had a higher hospitalization risk (very low Relative Risk (RR) 1.31, 95% Confidence Interval (CI) 1.17-1.47; p < 0.001, low RR 1.16, 95%CI 1.04-1.30; p = 0.008, and moderate RR 1.15, 95%CI 1.05-1.25; p = 0.001). In addition, CwCF in the very low group had a higher respiratory-related hospitalization risk (RR 1.60, 95%CI 1.30-1.90; p < 0.01).

CwCF in the lower COI quintiles had a higher hospitalization risk. Future research should focus on underlying area-level drivers of hospitalizations to reduce inpatient utilization.