1. In a retrospective study, patients with lower neighborhood advantage are hospitalized more frequently, have greater disease severity, and have increased mortality compared to those with higher neighborhood advantage.

2. Diagnoses disproportionally affecting lower neighborhood advantage patients include type 2 diabetes with complications, asthma, and sleep apnea.

Evidence Rating Level: 2 (Good)

Study Rundown: There are many neighborhood-level factors believed to affect illness severity and hospitalization. One metric of neighborhood-level factors, the Child Opportunity Index (COI), is a validated tool of child opportunity associated with disparities in hospitalizations. This study aimed to further describe this association by utilizing a retrospective cross-sectional design to evaluate the association of COI with admissions and disease severity across children’s hospitals in the United States. Researchers found that those from less advantaged neighborhoods were more likely to be hospitalized, require mechanical ventilation, and have public insurance. They also required more critical care and had increased mortality. Lower COI was also associated with higher severity of illness in various conditions such as asthma, acute bronchiolitis, COVID-19, diabetic ketoacidosis (DKA), and intracranial injury. Diagnoses associated more with lower neighborhood advantage (lower COI) included type 2 diabetes with complications, asthma, and sleep apnea, whereas higher neighborhood advantage was more associated with mood disorders, scoliosis, and suicide and self-inflicted injury. One limitation of the study is related to its use of postal code data to derive COI, which may be less sensitive to variations within neighborhoods than a census tract. Overall, this study provides evidence that lower neighborhood opportunity as measured by COI is associated with poor health outcomes.

Click here to read the article in the Journal of Pediatrics

Relevant Reading: Neighborhood Child Opportunity and Individual-Level Pediatric Acute Care Use and Diagnoses

In Depth [retrospective cohort]: The Child Opportunity Index (COI) is a validated tool with 29 indicators of child opportunity using the patient’s home postal code, with 3 main domains including education, home and environment, and social and economic factors. Using a retrospective cross-sectional design, this study acquired data from children’s hospitals from the Pediatric Health Information System database between July 2020 August 2021. This included 773,743 encounters for children <18 years admitted to 39 children’s hospitals in the United States. There were great proportion of hospitalizations among very low (22.0%) and low (20.5%) COI areas compared with high (18.8%) and very high COI groups (18.9%). Diagnoses associated more with lower neighborhood advantage (lower COI) included type 2 diabetes with complications, asthma, and sleep apnea. In contrast, higher neighborhood advantage was associated with mood disorders, scoliosis, and suicide and self-inflicted injury. Lower COI had increased risk of ICU admission, with aOR of 1.10 (95% CI 1.08-1.13) in very high COI, aOR of 1.12 (95% CI 1.10-1.15) in moderate COI, aOR of 1.14 (95% CI 1.12-1.17) in low COI, and 1.14 (95% CI 1.11-1.17) in very low COI groups. Similarly, lower COI had an increased risk of mortality, with aOR of 1.22 (95% CI 1.07-1.39) in very high COI, aOR of 1.24 (95% CI 1.09-1.41) in moderate COI, aOR of 1.36 (95% CI 1.20-1.55) in low COI, and 1.49 (95% CI 1.31-1.70) in very low COI groups.

Image: PD

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