PC3073: Geographical Variation in Childhood Opportunity

Background: The Childhood Opportunity Index (COI) is a metric of local and regional neighborhood factors highlighting social disparities that impact childhood development and wellbeing. It is unknown if COI varies geographically for hospitalized children. We sought to describe COI among hospitalized children by United States Census Geographic Regions (USCGR) and explore for relationships with poor clinical outcomes.

Methods: We performed a retrospective, multicenter cohort study assessing children ( < 18 years) admitted to 47 children’s hospitals from January 2018 through December 2019 via the Pediatric Hospital Information System registry. Primary outcome was COI by USCGR. Secondary outcomes were demographics, payor categories, and household incomes. Exploratory clinical outcomes were rates of mortality, Pediatric Intensive Care Unit (PICU) admission, mechanical ventilation (MV), extracorporeal life support, and length of stay (LOS). Descriptive, comparative (chi-square, ANOVA and Kruskal-Wallis tests), and associative (logistic/linear modelling) statistics were employed.

Results: Descriptive features by COI are found in Table 1. Of the 132,130 encounters studied, 44.1% had low or very low COI. Rates varied by USCGR (Figure 1) with very low COI common to East South Central (22%) and West South-Central regions (32%) as compared to New England (5.4%). In exploratory modelling accounting for USCGR, COI was associated with mortality (odds ratio [OR]: 0.89, 95% confidence interval [CI]: 0.85-0.94), PICU admission (OR: 0.98, 95%CI: 0.97-0.99), MV (OR: 0.96, 95%CI: 0.94-0.97), and LOS (p < 0.001). Hispanic and Black children were more likely to live in very low COI neighborhoods (29% and 39% respectively) vs very high (9% and 8%). White children were more likely to live in very high COI neighborhoods (70%).

Conclusion: In this large, multicenter study, COI of hospitalized children varied by USCGR. Additionally, racial and ethnic disparities exist amongst COI with more Black and Hispanic children in lower opportunity neighborhoods. Mortality, PICU admission, MV, and LOS varied by COI with lower COI associated with higher mortality, increased likelihood of PICU admission and increased LOS. The observed associations between COI and mortality, LOS, PICU admission, and by USCGR represent gaps for public health initiatives to establish equitable healthcare.