PC2078: Child Opportunity Index Scores Are Associated with Disparities in Rates of Emergency Department and Hospital Utilization on a Neighborhood Level

Background: Social determinants of health (SDOH) and inequities in healthcare are growing fields of interest. However, due to methodological challenges, quantitative data are limited, and most studies have focused on adult metrics. The Child Opportunity Index (COI) is a unified measure of SDOH across three domains (education, health and environment, social and economic), using indicators that are especially relevant to children. The COI assesses neighborhoods with local specificity on the level of census tracts. I hypothesized that disparities in healthcare utilization would be reflected by the COI.

Methods: I examined Medicaid data for emergency department (ED) and hospital visits by pediatric patients in Michigan in 2017, exploring associations with SDOH as determined by the COI of each census tract. After excluding 74 census tracts that are either water-only or special land-use areas with little or no residential population, there remained 2,739 tracts in the state. Nationally-normed COI ratings as of 2015 were available for 2,731 census tracts (99.7%). ED and hospital visit data were available for 2,709 census tracts (98.9%; data for tracts with 5 or fewer visits were suppressed), encompassing 289,696 pediatric visits.

Results: Of the 289,696 ED and hospital visits by pediatric patients in Michigan in 2017 for which COI data were available, there was an inverse correlation with neighborhood opportunity (Figure 1). This trend was demonstrated in both absolute number of visits and in rates adjusted for the size of pediatric populations within each census tract. On average, a 10-point increase in COI score (indicating better opportunity) was associated with a decrease of 2.5 visits per 100 children (Figure 2; 95% confidence interval -2.3 to -2.6).

Conclusion: These data support the idea that healthcare utilization varies by SDOH on a local level, possibly due to disparities in accessing preventive care. The COI is a comprehensive tool to examine SDOH, with validity in content, predictive value, and measure of equity. Such sociological methods can offer insights that can inform both physicians and policymakers. Future work will investigate specific opportunities for community and neighborhood improvement.