Association of neighborhood opportunity and pediatric hospitalization rates in the United States

Abstract

We examined associations between a validated, multidimensional measure of social determinants of health and population-based hospitalization rates among children <18 years across 18 states from the 2017 Healthcare Cost and Utilization Project State Inpatient Databases and the US Census. The exposure was ZIP code-level Child Opportunity Index (COI), a composite measure of neighborhood resources and conditions that matter for children's health. The cohort included 614,823 hospitalizations among a population of 29,244,065 children (21.02 hospitalizations per 1000). Adjusted hospitalization rates decreased significantly and in a stepwise fashion as COI increased (p < .001 for each), from 26.56 per 1000 (95% confidence interval [CI] 26.41-26.71) in very low COI areas to 14.76 per 1000 (95% CI 14.66-14.87) in very high COI areas (incidence rate ratio 1.8; 95% CI 1.78-1.81). Decreasing neighborhood opportunity was associated with increasing hospitalization rates among children in 18 US states. These data underscore the importance of social context and community-engaged solutions for health systems aiming to eliminate care inequities.

Figure.

Adjusted Hospitalization Rates per 1000 Children, Overall and by Clinical Diagnosis. X-axis represents COI 2.0 Child Opportunity Level quintiles from Very Low to Very High. All differences are significant at P<.001. IRR = Incidence Rate Ratio (95% Confidence Intervals) comparing adjusted hospitalization rates between Very Low and Very High COI Opportunity Levels ^a Infectious disease, respiratory includes acute bronchiolitis and pneumonia ^b Infectious disease, non-respiratory includes cellulitis, urinary tract infections, and gastroenteritis ^c Mood disorders includes major depressive disorders, mood disorders, bipolar disorders, suicide and intentional self-inflicted injury and adjustment disorders ^e DKA=diabetic ketoacidosis COI = Child Opportunity Index 2.0