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Toce MS, Narang C, Monuteaux MC, Bourgeois FT. The Association of the Child Opportunity Index with Emergency Department Presentations for Pediatric Poisonings: A Case-Control Study. J Pediatr 2024; 277:114410. [PMID: 39551092 DOI: 10.1016/j.jpeds.2024.114410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 10/15/2024] [Accepted: 11/12/2024] [Indexed: 11/19/2024]
Abstract
OBJECTIVE To examine the relationship between the Child Opportunity Index (COI) and unintentional poisonings in a geographically diverse pediatric population. STUDY DESIGN We conducted a retrospective, case-control study of children ≤ 6 years of age who had emergency department encounters for poisonings from January 1, 2016, to December 31, 2021. Data were obtained from the Pediatric Health Information System database. Poisonings were categorized as related to prescription medications, over-the-counter medications, drugs of misuse, or nonmedicinal substances. We estimated multivariable conditional logistic regression models to examine the association of the COI with each poisoning type. RESULTS Among 49 789 emergency department encounters for poisonings, the most common poisoning category was prescription medications (28.3%). Compared with patients with very low COI, patients with very high COI were more likely to present for prescription medication (aOR 1.15 [95% CI, 1.01-1.31]) or over-the-counter medication poisoning (aOR 1.37 [95% CI, 1.18-1.59]). Conversely, patients with very high COI were less likely to have poisonings secondary to drugs of misuse (aOR 0.82 [95% CI, 0.67-0.99]). Patients with high COI were also less likely to have poisonings due to a nonmedicinal substance compared with patients with very low COI (aOR 0.83 [95% CI, 0.73-0.93]). CONCLUSIONS Different pediatric poisoning types were associated with a patient's COI, possibly reflecting socioeconomic characteristics of a child's environment. While poison prevention strategies should be employed uniformly to maximize impact, our findings highlight variation in poisoning risks related to a child's environment and support the use of the COI for future research into mechanisms to strengthen further poisoning prevention strategies.
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Affiliation(s)
- Michael S Toce
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
| | - Claire Narang
- University of Miami Miller School of Medicine, Miami, FL
| | - Michael C Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Florence T Bourgeois
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Computational Health Informatics Program (CHIP), Boston Children's Hospital, Boston, MA
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Cockrell HC, Shah NR, Krinock D, Siddiqui SM, Englum BR, Meckmongkol TT, Koo N, Murphy J, Richards MK, Martin K. Health Disparities Research: What Every Pediatric Surgeon Should Know. J Pediatr Surg 2024; 59:161636. [PMID: 39122610 DOI: 10.1016/j.jpedsurg.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 06/05/2024] [Accepted: 07/15/2024] [Indexed: 08/12/2024]
Abstract
While the earliest published health disparity research in the United States dates to 1899, the field was not formally established until the late 20th century. Initially focused on race and ethnicity, the field has broadened to include socioeconomic status. Several measures have been developed to quantify socioeconomic disadvantage, including the Social Vulnerability Index, Area Deprivation Index, and Child Opportunity Index. These indices have been validated and demonstrate correlation with health outcomes. However, socioeconomic status cannot fully explain health inequities experienced by people of minoritized racial and ethnic identities. Three generations of health disparities research have been described-identification of disparities, root analysis, and development of interventions to mitigate health inequities. While there has been an increase in publication of health disparity research, there is little third generation work. It is imperative that health disparities research move beyond defining the problem and toward interventions that will reduce health inequities. LEVELS OF EVIDENCE: Level IV.
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Affiliation(s)
- Hannah C Cockrell
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Nikhil R Shah
- Section of Pediatric Surgery, C.S. Mott Children's Hospital, 1540 E. Hospital Dr, Ann Arbor, MI 48109, USA
| | - Derek Krinock
- Department of Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA
| | - Sabina M Siddiqui
- Division of Pediatric Surgery, Arkansas Children's Northwest Hospital, 2601 Gene George Blvd, Springdale, AR 72762, USA
| | - Brian R Englum
- Division of Pediatric Surgery, University of Maryland Children's Hospital, 29 South Greene St Suite GS110, Baltimore, MD 21201, USA
| | - Teerin T Meckmongkol
- Division of Pediatric Surgery, Nemours Children's Health Orlando, 6535 Nemours Pkwy, Orlando, FL 32827, USA
| | - Nathaniel Koo
- Division of Pediatric Surgery, University of Illinois Hospital and Health Sciences System, 840 S. Wood Street, Suite 416, Chicago, IL 60612, USA
| | - Jennifer Murphy
- Division of Pediatric Surgery, Atlantic Medical Group, 1000 Madison Ave, Morristown, NJ 07960, USA
| | - Morgan K Richards
- Division of Pediatric Surgery, St. Luke's Children's Hospital, 305 E Jefferson St, Boise, ID 83712, USA
| | - Kathryn Martin
- Division of Pediatric Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, 100 Woods Rd, MFCH 1123, Valhalla, NY 10595, USA
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Tyris J, Putnick DL, Parikh K, Lin TC, Sundaram R, Yeung EH. Place-Based Opportunity and Well Child Visit Attendance in Early Childhood. Acad Pediatr 2024; 24:1220-1228. [PMID: 38936606 PMCID: PMC11513235 DOI: 10.1016/j.acap.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/23/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Lower neighborhood opportunity, measured by the Child Opportunity Index [COI], is associated with increased pediatric morbidity, but is less frequently used to examine longitudinal well child care. We aimed to evaluate associations between the COI and well child visit [WCV] attendance from birth - <36 months of age. METHODS The Upstate KIDS population-based birth cohort includes children born 2008-2010 in New York state. The exposure, 2010 census tract COI (very low [VL] to very high [VH]), was linked to children's geocoded residential address at birth. The outcome was attended WCVs from birth - <36 months of age. Parents reported WCVs and their child's corresponding age on questionnaires every 4-6 months. These data were applied to appropriate age ranges for recommended WCVs to determine attendance. Associations were modeled longitudinally as odds of attending visits and as mean differences in proportions of WCVs by COI. RESULTS Among 4650 children, 21% (n = 977) experienced VL or low COI. Children experiencing VL (adjusted OR [aOR] 0.68, 95% CI 0.61, 0.76), low (aOR 0.81, 95% CI 0.73, 0.90), and moderate COI (aOR 0.88, 95% CI 0.81, 0.96), compared to VH COI, had decreased odds of attending any WCV. The estimated, adjusted mean proportions of WCV attendance were lower among children experiencing VL (0.45, P < .01), low (0.53, P = .02), moderate (0.53, P = .05), and high (0.54, P = .03) compared to VH COI (0.56). CONCLUSIONS Lower COI at birth was associated with decreased WCV attendance throughout early childhood. Reducing barriers to health care access for children experiencing lower COI may advance equitable well child care.
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Affiliation(s)
- Jordan Tyris
- Division of Hospital Medicine, Children's National Hospital (J Tyris and K Parikh), Washington, DC; Department of Pediatrics, George Washington University School of Medicine and Health Sciences (J Tyris and K Parikh), Washington, DC; Epidemiology Branch (J Tyris, DL Putnick, and EH Yeung), Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md.
| | - Diane L Putnick
- Epidemiology Branch (J Tyris, DL Putnick, and EH Yeung), Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md
| | - Kavita Parikh
- Division of Hospital Medicine, Children's National Hospital (J Tyris and K Parikh), Washington, DC; Department of Pediatrics, George Washington University School of Medicine and Health Sciences (J Tyris and K Parikh), Washington, DC
| | | | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch (R Sundaram), Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md
| | - Edwina H Yeung
- Epidemiology Branch (J Tyris, DL Putnick, and EH Yeung), Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md
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Bent MA, Jhun M, Beltran V, Fimbres B, Wren TAL. Social Disadvantage and Transportation Insecurity in Clubfoot Clinic. J Pediatr Orthop 2024:01241398-990000000-00684. [PMID: 39428577 DOI: 10.1097/bpo.0000000000002823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2024]
Abstract
OBJECTIVES This study aims to evaluate the association of missing clubfoot clinic visits with transportation barriers and measures of socioeconomic status including the child opportunity index (COI). METHODS An 11-question survey was administered to caregivers of patients with clubfoot seen at a single pediatric tertiary hospital between August 2020 and September 2023. A chart review was conducted to obtain zip codes used to determine COI 2.0 scores. The impact of race/ethnicity, income, persons per household, COI, and transportation methods on missing at least one clinic visit was analyzed using descriptive and nonparametric statistics. RESULTS The transportation survey was completed by a total of 99 caregivers. The median travel time to the clinic was 45 minutes (IQR: 33, range: 1 to 180). Most participants reported use of a personal car (108/128, 83%), and 72% took time off work to attend the appointment. Those with lower COI had longer travel time (P=0.02) and were less likely to use personal cars (P=0.05). Missed clubfoot clinic visits were more common for families reliant on transportation other than a personal vehicle (P=0.01) and those with annual income under $30,000 (P=0.02). CONCLUSIONS Transportation insecurity was associated with greater social disadvantage as indicated by COI and more missed clinic visits. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Melissa A Bent
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Michelle Jhun
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles
| | - Veronica Beltran
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles
| | - Barbara Fimbres
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles
| | - Tishya A L Wren
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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5
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Willer BL, Mpody C, Tobias JD, Nafiu OO, Jimenez N. Association of Neighborhood Opportunity, Race, and Ethnicity with Pediatric Day-of-surgery Cancellations: A Cohort Study. Anesthesiology 2024; 141:657-669. [PMID: 38787688 DOI: 10.1097/aln.0000000000005042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
BACKGROUND Day-of-surgery cancellations impede healthcare access and contribute to inequities in pediatric healthcare. Socially disadvantaged families have many risk factors for surgical cancellation, including low health literacy, transportation barriers, and childcare constraints. These social determinants of health are captured by the Child Opportunity Index 2.0, a national quantification of neighborhood-level characteristics that contribute to a child's vulnerability to adversity. This study examined the association of neighborhood opportunity with pediatric day-of-surgery cancellations. METHODS A retrospective cohort study of children younger than 18 yr of age scheduled for ambulatory surgery at a tertiary pediatric hospital between 2017 and 2022 was conducted. Primary addresses were geocoded to determine Child Opportunity Index 2.0 neighborhood opportunity. Log-binomial regression was used to estimate the relative risk of day-of-surgery cancellation comparing different levels of neighborhood opportunity. This study also estimated the relative risk of cancellations associated with race and ethnicity, by neighborhood opportunity. RESULTS Overall, the incidence of day-of-surgery cancellation was 3.8%. The incidence of cancellation was lowest in children residing in very-high-opportunity neighborhoods and highest in children residing in very-low-opportunity neighborhoods (2.4% vs. 5.7%, P < 0.001). The adjusted relative risk of day-of-surgery cancellation in very-low-opportunity neighborhoods compared to very-high-opportunity neighborhoods was 2.24 (95% CI, 2.05 to 2.44; P < 0.001). The results showed statistical evidence of an interaction of Children's Opportunity Index with race and ethnicity. In very-low-opportunity neighborhoods, Black children had 1.48 times greater risk of day-of-surgery cancellation than White children (95% CI, 1.35 to 1.63; P < 0.001). Likewise, in very-high-opportunity neighborhoods, Black children had 2.17 times greater risk of cancellation (95% CI, 1.75 to 2.69; P < 0.001). CONCLUSIONS This study found a strong relationship between pediatric day-of-surgery cancellation and neighborhood opportunity. Black children at every level of opportunity had the highest risk of cancellation, suggesting that there are additional factors that render them more vulnerable to neighborhood disadvantage. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Brittany L Willer
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Christian Mpody
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Olubukola O Nafiu
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Nathalia Jimenez
- Department of Anesthesiology, University of Washington-Seattle Children's Hospital, Seattle, Washington
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Magee PM, Asp RA, Myers CN, Grunwell JR, Paquette E, Akande MY. Assessing Social Determinants of Health During Critical Illness: Implications and Methodologies. Crit Care Clin 2024; 40:623-640. [PMID: 39218477 DOI: 10.1016/j.ccc.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
A growing body of literature has identified social determinants of health (SDoH) as potential contributors to health disparities in pediatric critical illness. Pediatric critical care providers should use validated screening tools to identify unmet social needs and ensure appropriate referral through multisector partnerships. Pediatric critical care researchers should consider factors outside of race and insurance status and explore the association between neighborhood-level factors and disparate health outcomes during critical illness. Measuring and addressing the SDoH at the individual and neighborhood level are important next steps in mitigating health disparities for critically ill pediatric patients.
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Affiliation(s)
- Paula M Magee
- Division of Pediatric Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 9 Main Suite 9NW45, Philadelphia, PA 19104, USA.
| | - Rebecca A Asp
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, 3333 Burnet Avenue, ML 2005, Cincinnati, OH 45229, USA
| | - Carlie N Myers
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, 3333 Burnet Avenue, ML 2005, Cincinnati, OH 45229, USA
| | - Jocelyn R Grunwell
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Road Northeast, Tower 1, 4th Floor, PCCM Offices, Atlanta GA 30322, USA. https://twitter.com/GrunwellJocelyn
| | - Erin Paquette
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Chicago, IL 60611, USA
| | - Manzilat Y Akande
- Section of Critical Care, Department of Pediatrics, Oklahoma University Health Sciences Center, 1100 North Lindsay Avenue, Oklahoma City, OK 73104, USA
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Ugalde IT, Schroeder AR, Marin JR, Hall M, McCoy E, Goyal MK, Molloy MJ, Stephens JR, Steiner MJ, Tchou MJ, Markham JL, Cotter JM, Noelke C, Morse R, House SA. Childhood Opportunity Index and Low-Value Care in Children's Hospitals. Pediatrics 2024; 154:e2023065524. [PMID: 39246171 PMCID: PMC11442119 DOI: 10.1542/peds.2023-065524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/18/2024] [Accepted: 06/25/2024] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Few studies have explored the relationship between social drivers of health and pediatric low-value care (LVC). We assessed the relationship between Childhood Opportunity Index (COI) 2.0 and LVC in children's hospitals. METHODS We applied the Pediatric Health Information System LVC Calculator to emergency and inpatient encounters from July 2021 through June 2022. Proportions with LVC in highest (greatest opportunity) and lowest COI quintiles were compared. Generalized estimating equation logistic regression models were used to analyze LVC trends across COI quintiles. RESULTS 842 463 encounters were eligible for 20 LVC measures. Across all measures, odds of LVC increased across increasing COI quintiles (adjusted odds ratio [OR] 1.06, 95% confidence interval [CI] 1.03-1.08). For 12 measures, LVC was proportionally more common in highest versus lowest COI quintile, whereas the reverse was true for 4. Regression modeling revealed increasing LVC as COI increased across all quintiles for 10 measures; gastric acid suppression for infants had the strongest association (OR 1.22, 95% CI 1.17-1.27). Three measures revealed decreasing LVC across increasing COI quintiles; Group A streptococcal testing among children <3 years revealed the lowest OR (0.85, 95% CI 0.73-0.99). The absolute volume of LVC delivered was greatest among low COI quintiles for most measures. CONCLUSIONS Likelihood of LVC increased across COI quintiles for 10 of 20 measures, whereas 3 measures revealed reverse trends. High volumes of LVC across quintiles support a need for broad de-implementation efforts; measures with greater impact on children with lower opportunity warrant prioritized efforts.
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Affiliation(s)
- Irma T. Ugalde
- Department of Emergency Medicine, McGovern Medical School
at UTHealth, Houston, Texas
| | - Alan R. Schroeder
- Department of Pediatrics, Stanford University School of
Medicine, Palo Alto, California
| | | | - Matt Hall
- Children’s Hospital Association, Lenexa,
Kansas
| | - Elisha McCoy
- Department of Pediatrics, Le Bonheur Children’s
Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Monika K. Goyal
- Children’s National Medical Center, Washington,
District of Columbia
| | - Matthew J. Molloy
- Cincinnati Children’s Hospital Medical Center,
University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | | | - Jessica L. Markham
- Department of Pediatrics, Children’s Mercy Kansas
City, University of Missouri-Kansas City School of Medicine, Kansas City,
Missouri
| | | | | | - Rustin Morse
- Center for Clinical Excellence, Nationwide
Children’s Hospital, Columbus, Ohio
| | - Samantha A. House
- Department of Pediatrics, Dartmouth Health
Children’s, Lebanon, New Hampshire
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Belanoff C, Black A, Ncube CN, Acevedo-Garcia D, Almeida J. Neighborhood Child Opportunity and Preterm Birth Rates by Race and Ethnicity. JAMA Netw Open 2024; 7:e2432766. [PMID: 39259538 PMCID: PMC11391324 DOI: 10.1001/jamanetworkopen.2024.32766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/15/2024] [Indexed: 09/13/2024] Open
Abstract
Importance In the US, infants born to non-Hispanic Black birthing parents are 50% more likely to be born preterm than those born to non-Hispanic White birthing parents, and individual-level factors do not fully account for this inequity. Neighborhood context, rooted in historic patterns of structural racism, may facilitate understanding patterns of inequity in preterm birth. Objective To estimate the association between neighborhood opportunity level, measured by the Child Opportunity Index (COI), and preterm birth among infants in Massachusetts. Design, Setting, and Participants In this cross-sectional, population-based study, Massachusetts birth certificates from 3 large metropolitan areas (Boston, Springfield, and Worcester) were linked to US Census tract-level data from the COI, and log binomial regression models and generalized estimating equations were fit to examine associations of different levels of opportunity with preterm birth. Singleton infants born in Massachusetts between February 1, 2011, and December 31, 2015, were included. Analyses were originally conducted in 2019 and updated in 2024. Exposure Level of child opportunity (measured by the COI) at the US Census tract level. Race and ethnicity were ascertained from the birth certificate, as reported by the birthing parent. Main Outcomes and Measures Live birth before 37 completed weeks' gestation. Results The analytic dataset included 267 553 infants, of whom 18.9% were born to Hispanic, 10.1% to non-Hispanic Asian or Pacific Islander, 10.1% to non-Hispanic Black, and 61.0% to non-Hispanic White birthing parents. More than half of infants born to non-Hispanic Black and Hispanic birthing parents were born into very low opportunity neighborhoods, and in crude models, this was associated with greater prevalence of preterm birth relative to very high opportunity neighborhoods (prevalence ratio, 1.44; 95% CI, 1.37-1.52). After adjustment for covariates, infants born into very low opportunity neighborhoods still had a greater prevalence of preterm birth (prevalence ratio, 1.16; 95% CI, 1.10-1.23). Conclusions and Relevance In this cross-sectional study of neighborhood opportunity and preterm birth, elevated risk associated with exposure to a very low opportunity neighborhood, coupled with the disproportionate exposure by race and ethnicity, points to a modifiable factor that may contribute to racial and ethnic inequities in preterm birth. Future research should investigate interventions that seek to address neighborhood opportunity.
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Affiliation(s)
- Candice Belanoff
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Adriana Black
- Office of the Vice Chancellor for Health Affairs, University of Illinois, Chicago
| | - Collette N. Ncube
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | | | - Joanna Almeida
- Simmons University School of Social Work, Boston, Massachusetts
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Zolotor A, Huang RW, Bhavsar NA, Cholera R. Comparing Social Disadvantage Indices in Pediatric Populations. Pediatrics 2024; 154:e2023064463. [PMID: 39143925 PMCID: PMC11350100 DOI: 10.1542/peds.2023-064463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Place-based social disadvantage indices are increasingly used to promote health equity, but vary in design. We compared associations between 3 commonly used indices (Social Vulnerability Index [SVI], Area Deprivation Index [ADI], and Child Opportunity Index [COI]) and infant well-child check (WCC) attendance and adolescent obesity. We hypothesized that the COI would have the strongest association with child health outcomes. METHODS We conducted a cross-sectional analysis of 2014-2019 Duke University Health System electronic health record data. Eligible participants were ≤18 years old, had outpatient encounters during the study period, and resided in Durham County, North Carolina. We aggregated indices into deciles; higher deciles represented greater disadvantage. Multivariable logistic regression models quantified the association between each index and infant WCC attendance (ages 0-15 months) and adolescent obesity (11-17 years). RESULTS There were 10 175 and 14 961 children in the WCC and obesity cohorts, respectively. All 3 indices were similarly associated with WCCs (SVI odds ratio [OR] 1.10, 95% confidence interval [CI] 1.08-1.12; ADI OR 1.10, 95% CI 1.08-1.12; COI OR 1.12, 95% CI 1.10-1.14) and obesity (SVI OR 1.06, 95% CI 1.04-1.07; ADI OR 1.08, 95% CI 1.06-1.10; COI OR 1.07, 95% CI 1.05-1.08). ORs indicate the increase in the outcome odds for every 1-decile index score increase. CONCLUSIONS Higher disadvantage as defined by all 3 indices was similarly associated with adolescent obesity and decreased infant WCC attendance. The SVI, ADI, and COI may be equally suitable for pediatric research, but population and outcome characteristics should be considered when selecting an index.
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Affiliation(s)
- Anna Zolotor
- Duke-Margolis Institute for Health Policy, Washington, District of Columbia
| | - Ro W. Huang
- Duke-Margolis Institute for Health Policy, Washington, District of Columbia
- Trinity College of Arts & Sciences, Duke University, Durham, North Carolina
| | | | - Rushina Cholera
- Duke-Margolis Institute for Health Policy, Washington, District of Columbia
- Population Health Sciences
- Pediatrics, Duke University School of Medicine, Durham, North Carolina
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10
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Gross E, Jakubowski E, Sahai S. Social Determinants of Health in Hospitalized Children. Pediatr Ann 2024; 53:e337-e344. [PMID: 39240180 DOI: 10.3928/19382359-20240703-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
It has long been established that the environment in which a child grows and develops shapes their social and health outcomes. After all, collecting social history is a key component of a health care visit. In recent decades, the importance of social determinants of health (SDOH) has been rediscovered, and the impact of adverse childhood experiences has garnered great attention. Estimates show that health outcomes are influenced more by factors outside of health care, such as our patients' SDOH. Addressing SDOH is fundamental for improving health and reducing longstanding inequities in health. While understanding that SDOH needs to be addressed through the continuum of pediatric care, this article will focus on SDOH in the pediatric inpatient setting. [Pediatr Ann. 2024;53(9):e337-e344.].
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11
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Davis DW, Jawad K, Feygin YB, Stevenson M, Wattles B, Jones VF, Porter J, Lohr WD, Le J. The Relationships Among Neighborhood Disadvantage, Mental Health and Developmental Disabilities Diagnoses, and Race/Ethnicity in a U.S. Urban Location. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01751-w. [PMID: 39192086 DOI: 10.1007/s10578-024-01751-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2024] [Indexed: 08/29/2024]
Abstract
Childhood health disparities by race have been found. Neighborhood disadvantage, which may result from racism, may impact outcomes. The aim of the study is to describe the distribution of mental health (MH) and developmental disabilities (DD) diagnosis across Child Opportunity Index (COI) levels by race/ethnicity. A cross-sectional study using 2022 outpatient visit data for children < 18 years living in the Louisville Metropolitan Area (n = 115,738) was conducted. Multivariable logistic regression analyses examined the association between diagnoses and COI levels, controlling for sex and age. Almost 18,000 children (15.5%) had a MH or DD (7,905 [6.8%]) diagnosis. In each COI level, the prevalence of MH diagnosis was lower for non-Hispanic (N-H) Black than for N-H White children. In adjusted analyses, there were no significant associations between diagnoses and COI for non-White children for MH or DD diagnoses. The odds of receiving a MH [OR: 1.74 (95% CI: 1.62, 1.87)] and DD [OR: 1.69 (95% CI: 1.51, 1.88)] diagnosis were higher among N-H White children living in Very Low compared to Very High COI areas. Current findings suggest that COI does not explain disparities in diagnosis for non-White children. More research is needed to identify potential multi-level drivers such as other forms of racism. Identifying programs, policies, and interventions to reduce childhood poverty and link children and families to affordable, family-centered, quality community mental and physical health resources is needed to ensure that families can build trusting relationships with the providers while minimizing stigma.
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Affiliation(s)
- Deborah Winders Davis
- Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Louisville, KY, 40202, USA.
- Norton Children's Research Institute Affiliated With the University of Louisville School of Medicine, Louisville, KY, USA.
| | - Kahir Jawad
- Norton Children's Research Institute Affiliated With the University of Louisville School of Medicine, Louisville, KY, USA
| | - Yana B Feygin
- Norton Children's Research Institute Affiliated With the University of Louisville School of Medicine, Louisville, KY, USA
| | - Michelle Stevenson
- Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Louisville, KY, 40202, USA
- Norton Children's Medical Group, Louisville, KY, USA
| | - Bethany Wattles
- Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Louisville, KY, 40202, USA
| | - Veronnie Faye Jones
- Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Louisville, KY, 40202, USA
- University of Louisville Health Science Center Office of Diversity and Inclusion, Louisville, KY, USA
| | - Jennifer Porter
- Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Louisville, KY, 40202, USA
- Norton Children's Medical Group, Louisville, KY, USA
| | - W David Lohr
- Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Louisville, KY, 40202, USA
- Norton Children's Medical Group, Louisville, KY, USA
- Kentucky Cabinet for Health and Family Services, Frankfort, KY, USA
| | - Jennifer Le
- Department of Pediatrics, University of Louisville School of Medicine, 571 S. Floyd Street, Louisville, KY, 40202, USA
- Norton Children's Medical Group, Louisville, KY, USA
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12
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Kim HA, Yu AG, Kim NP, Iqbal MS, Butts R. Lower opportunity ZIP code is associated with worse outcomes after listing in pediatric heart transplantation. J Heart Lung Transplant 2024; 43:1298-1307. [PMID: 38704128 DOI: 10.1016/j.healun.2024.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/14/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The Child Opportunity Index (COI) comprehensively measures children's social determinants of health. We describe association between COI and outcomes after listing for heart transplantation. METHODS We conducted a retrospective review of the United Network for Organ Sharing (UNOS) database for U.S. children listed for heart transplant between 2012 and 2020. ZIP codes were utilized to assign COI. Primary outcome was survival from time of listing. Secondary outcomes included waitlist survival, 1-year post-transplant survival, and conditional 1-year post-transplant survival. Cox regression was performed adjusting for payor, age, race, diagnosis, and support at listing for all outcomes except waitlist survival, for which Fine-Gray competing risk analysis was performed. RESULTS Of 5,723 children listed, 109 were excluded due to missing ZIP codes. Race/ethnicity and payor were associated with COI (p < 0.001). Patients living in very low COI ZIP codes compared to all others had increased mortality from time of listing (HR 1.16, CI 1.03-1.32, p = 0.02) with 1-, 5-, and 9-year survival of 79.3% vs 82.2%, 66.5% vs 73.0%, and 53.6% vs 64.7% respectively, were more likely to be removed from the waitlist due to death or being too sick (subdistribution HR 1.26, 95% CI 1.10-1.42), and had increased mortality conditional on one-year post-transplant survival (HR 1.38, 1.09-1.74, p = 0.008) with 1-, 3-, and 5- year survival of 94.7% vs 97.3%, 87.0% vs 93.1%, and 78.6% vs 86.9%. CONCLUSIONS Children living in lower opportunity ZIP codes had poorer survival from time of listing, poorer waitlist survival, and poorer conditional one-year post-transplant survival.
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Affiliation(s)
- Heidi A Kim
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas
| | - Andrew G Yu
- Division of Hospital Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas
| | - Nicole P Kim
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas
| | - Mehreen S Iqbal
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas
| | - Ryan Butts
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas.
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Akinkuotu AC, Burkbauer L, Phillips MR, Gallaher J, Williams FN, McLean SE, Charles AG. Neighborhood child opportunity is associated with hospital length of stay following pediatric burn injury. Burns 2024; 50:1487-1493. [PMID: 38705778 DOI: 10.1016/j.burns.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/21/2024] [Accepted: 03/31/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Pediatric burns are associated with socioeconomic disadvantage and lead to significant morbidity. The Child Opportunity Index (COI) is a well-validated measure of neighborhood characteristics associated with healthy child development. We sought to evaluate the relationship between COI and outcomes of burn injuries in children. METHODS We performed a single-institution retrospective review of pediatric (<16 years) burn admissions between 2015 and 2019. Based on United States residential zip codes, patients were stratified into national COI quintiles. We performed a multivariate Poisson regression analysis to determine the association between COI and increased length of stay. RESULTS 2095 pediatric burn admissions occurred over the study period. Most children admitted were from very low (n = 644, 33.2 %) and low (n = 566, 29.2 %) COI neighborhoods. The proportion of non-Hispanic Black patients was significantly higher in neighborhoods with very low (44.5 %) compared to others (low:28.8 % vs. moderate:11.9 % vs. high:10.5 % vs. very high:4.3 %) (p < 0.01). Hospital length of stay was significantly longer in patients from very low COI neighborhoods (3.6 ± 4.1 vs. 3.2 ± 4.9 vs. 3.3 ± 4.8 vs. 2.8 ± 3.5 vs. 3.2 ± 8.1) (p = 0.02). On multivariate regression analysis, living in very high COI neighborhoods was associated with significantly decreased hospital length of stay (IRR: 0.51; 95 % CI: 0.45-0.56). CONCLUSION Children from neighborhoods with significant socioeconomic disadvantage, as measured by the Child Opportunity Index, had a significantly higher incidence of burn injuries resulting in hospital admissions and longer hospital length of stay. Public health interventions focused on neighborhood-level drivers of childhood development are needed to decrease the incidence and reduce hospital costs in pediatric burns. TYPE OF STUDY Retrospective study LEVEL OF EVIDENCE: Level III.
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Affiliation(s)
- Adesola C Akinkuotu
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
| | - Laura Burkbauer
- Department of Surgery, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Michael R Phillips
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Jared Gallaher
- Division of Trauma and Acute Care, Department of Surgery, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Felicia N Williams
- North Carolina Jaycee Burn Center, Department of Surgery, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Sean E McLean
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Anthony G Charles
- Division of Trauma and Acute Care, Department of Surgery, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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14
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Zielonka B, Bucholz EM, Lu M, Bates KE, Hill GD, Pinto NM, Sleeper LA, Brown DW. Childhood Opportunity and Acute Interstage Outcomes: A National Pediatric Cardiology Quality Improvement Collaborative Analysis. Circulation 2024; 150:190-202. [PMID: 39008557 PMCID: PMC11251506 DOI: 10.1161/circulationaha.124.069127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/14/2024] [Accepted: 06/05/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND The interstage period after discharge from stage 1 palliation carries high morbidity and mortality. The impact of social determinants of health on interstage outcomes is not well characterized. We assessed the relationship between childhood opportunity and acute interstage outcomes. METHODS Infants discharged home after stage 1 palliation in the National Pediatric Quality Improvement Collaborative Phase II registry (2016-2022) were retrospectively reviewed. Zip code-level Childhood Opportunity Index (COI), a composite metric of 29 indicators across education, health and environment, and socioeconomic domains, was used to classify patients into 5 COI levels. Acute interstage outcomes included death or transplant listing, unplanned readmission, intensive care unit admission, unplanned catheterization, and reoperation. The association between COI level and acute interstage outcomes was assessed using logistic regression with sequential adjustment for potential confounders. RESULTS The analysis cohort included 1837 patients from 69 centers. Birth weight (P<0.001) and proximity to a surgical center at birth (P=0.02) increased with COI level. Stage 1 length of stay decreased (P=0.001), and exclusive oral feeding rate at discharge increased (P<0.001), with higher COI level. More than 98% of patients in all COI levels were enrolled in home monitoring. Death or transplant listing occurred in 101 (5%) patients with unplanned readmission in 987 (53%), intensive care unit admission in 448 (24%), catheterization in 345 (19%), and reoperation in 83 (5%). There was no difference in the incidence or time to occurrence of any acute interstage outcome among COI levels in unadjusted or adjusted analysis. There was no interaction between race and ethnicity and childhood opportunity in acute interstage outcomes. CONCLUSIONS Zip code COI level is associated with differences in preoperative risk factors and stage 1 palliation hospitalization characteristics. Acute interstage outcomes, although common across the spectrum of childhood opportunity, are not associated with COI level in an era of highly prevalent home monitoring programs. The role of home monitoring in mitigating disparities during the interstage period merits further investigation.
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Affiliation(s)
- Benjamin Zielonka
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, MA (B.Z., M.L., L.A.S., D.W.B.)
| | - Emily M. Bucholz
- Section of Cardiology, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado, Denver (E.M.B.)
| | - Minmin Lu
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, MA (B.Z., M.L., L.A.S., D.W.B.)
| | - Katherine E. Bates
- Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor (K.E.B.)
| | - Garick D. Hill
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, OH (G.D.H.)
| | - Nelangi M. Pinto
- Division of Cardiology, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, WA (N.M.P.)
| | - Lynn A. Sleeper
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, MA (B.Z., M.L., L.A.S., D.W.B.)
| | - David W. Brown
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, MA (B.Z., M.L., L.A.S., D.W.B.)
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15
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Daniels D. A Review of Respiratory Syncytial Virus Epidemiology Among Children: Linking Effective Prevention to Vulnerable Populations. J Pediatric Infect Dis Soc 2024; 13:S131-S136. [PMID: 38995088 DOI: 10.1093/jpids/piae017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/22/2024] [Indexed: 07/13/2024]
Abstract
Respiratory syncytial virus (RSV) is the greatest contributor to lower respiratory tract infections (LRTI) in children less than 5 years of age and the leading cause for infant hospitalizations in the United States (US). The burden of severe disease disproportionately impacts racial and ethnic minority groups, highlighting the need for interventions that promote health equity. Recent advancements in effective prophylactic agents have the potential to drastically alter the landscape of RSV disease among all young children. The effectiveness of prophylaxis, however, will rely on a clear understanding of RSV epidemiology. The purpose of this review is to discuss key aspects of RSV epidemiology while focusing on efforts to support equitable distribution of prophylactic agents to mitigate existing health disparities.
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Affiliation(s)
- Danielle Daniels
- Division of Pediatric Infectious Diseases, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, New York, USA
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16
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Maholtz D, Page-Goertz CK, Forbes ML, Nofziger RA, Bigham M, McKee B, Ramgopal S, Pelletier JH. Association Between the COI and Excess Health Care Utilization and Costs for ACSC. Hosp Pediatr 2024; 14:592-601. [PMID: 38919989 DOI: 10.1542/hpeds.2023-007526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/09/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND AND OBJECTIVES The authors of previous work have associated the Childhood Opportunity Index (COI) with increased hospitalizations for ambulatory care sensitive conditions (ACSC). The burden of this inequity on the health care system is unknown. We sought to understand health care resource expenditure in terms of excess hospitalizations, hospital days, and cost. METHODS We performed a retrospective cross-sectional study of the Pediatric Health Information Systems database, including inpatient hospitalizations between January 1, 2016 and December 31, 2022 for children <18 years of age. We compared ACSC hospitalizations, mortality, and cost across COI strata. RESULTS We identified 2 870 121 hospitalizations among 1 969 934 children, of which 44.5% (1 277 568/2 870 121) were for ACSCs. A total of 49.1% (331 083/674 548) of hospitalizations in the very low stratum were potentially preventable, compared with 39.7% (222 037/559 003) in the very high stratum (P < .001). After adjustment, lower COI was associated with higher odds of potentially preventable hospitalization (odds ratio 1.18, 95% confidence interval [CI] 1.17-1.19). Compared with the very high COI stratum, there were a total of 137 550 (95% CI 134 582-140 517) excess hospitalizations across all other strata, resulting in an excess cost of $1.3 billion (95% CI $1.28-1.35 billion). Compared with the very high COI stratum, there were 813 (95% CI 758-871) excess deaths, with >95% from the very low and low COI strata. CONCLUSIONS Children with lower neighborhood opportunity have increased risk of ACSC hospitalizations. The COI may identify communities in which targeted intervention could reduce health care utilization and costs.
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Affiliation(s)
- Danielle Maholtz
- Division of Critical Care Medicine, Department of Pediatrics
- Department of Pediatrics, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio
| | - Christopher K Page-Goertz
- Division of Critical Care Medicine, Department of Pediatrics
- Department of Pediatrics, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio
| | - Michael L Forbes
- Division of Critical Care Medicine, Department of Pediatrics
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio
- Department of Pediatrics, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio
| | - Ryan A Nofziger
- Division of Critical Care Medicine, Department of Pediatrics
- Department of Pediatrics, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio
| | - Michael Bigham
- Division of Critical Care Medicine, Department of Pediatrics
- Department of Pediatrics, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio
| | - Bryan McKee
- Division of Critical Care Medicine, Department of Pediatrics
- Department of Pediatrics, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio
| | - Sriram Ramgopal
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan H Pelletier
- Division of Critical Care Medicine, Department of Pediatrics
- Department of Pediatrics, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio
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17
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Zima BT, Edgcomb JB, Fortuna LR. Identifying Precise Targets to Improve Child Mental Health Care Equity: Leveraging Advances in Clinical Research Informatics and Lived Experience. Child Adolesc Psychiatr Clin N Am 2024; 33:471-483. [PMID: 38823818 PMCID: PMC11268960 DOI: 10.1016/j.chc.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
To reduce child mental health disparities, it is imperative to improve the precision of targets and to expand our vision of social determinants of health as modifiable. Advancements in clinical research informatics and please state accurate measurement of child mental health service use and quality. Participatory action research promotes representation of underserved groups in informatics research and practice and may improve the effectiveness of interventions by informing research across all stages, including the identification of key variables, risk and protective factors, and data interpretation.
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Affiliation(s)
- Bonnie T Zima
- UCLA Mental Health Informatics and Data Science (MINDS) Hub, Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, 37-384B, Los Angeles, CA 90024, USA.
| | - Juliet B Edgcomb
- UCLA Mental Health Informatics and Data Science (MINDS) Hub, Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, 37-372A, Los Angeles, CA 90024, USA
| | - Lisa R Fortuna
- Department of Psychiatry and Neuroscience, University of California Riverside, School of Medicine, 900 University Avenue, Riverside, CA 92521, USA
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18
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Srinivas S, Henderson K, Griffin KL, Thomas E, Wood RJ, Langer JC, Halaweish I. Rates of Hirschsprung-Associated Enterocolitis Decrease With Increasing Child Opportunity Index. J Pediatr Surg 2024; 59:1240-1244. [PMID: 38584009 DOI: 10.1016/j.jpedsurg.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/01/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Hirschsprung-associated enterocolitis (HAEC) is the most common cause of morbidity and mortality in patients with Hirschsprung disease (HD). There is a correlation between social determinants of health (SDOH) and outcomes in children with HD. The Child Opportunity Index (COI) is a publicly available dataset that stratifies patients by address into levels of opportunity. We aimed to understand if a relationship exists between COI and HAEC. METHODS A single-institution, IRB-approved, retrospective cohort study was performed of children with HD. Census tract information was used to obtain COI scores, which were stratified into categories (very low, low, medium, high, very high). Subgroups with and without history of HAEC were compared. RESULTS The cohort had 100 patients, of which 93 had a COI score. There were 27 patients (29.0%) with HAEC. There were no differences in demographics or clinical factors, including length of aganglionic colon, operative approach, and age at pull-through. As child opportunity score increased from very low to very high, there was a statistically significant decrease in the incidence of HAEC (p = 0.04). CONCLUSION We demonstrate a significant association between increasing opportunity and decreasing incidence of HAEC. This suggests an opportunity for targeted intervention in populations with low opportunity. LEVEL OF EVIDENCE III. IRB NUMBER IRB14-00232.
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Affiliation(s)
- Shruthi Srinivas
- Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Katelyn Henderson
- The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA
| | - Kristine L Griffin
- Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Elizabeth Thomas
- Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Richard J Wood
- Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Jacob C Langer
- Department of Surgery, Hospital for Sick Children at the University of Toronto, Toronto, Canada
| | - Ihab Halaweish
- Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
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Abraham OC, Jampa A, Quinney SK, Haas DM. The Childhood Opportunity Index's Association with Adverse Pregnancy and Newborn Outcomes in Nulliparous Persons. Am J Perinatol 2024; 41:e3052-e3058. [PMID: 37793429 DOI: 10.1055/a-2185-8882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The objective of the study was to determine if using a novel measure of social determinants of health, the Childhood Opportunity Index (COI), at the time of delivery was associated with development of adverse pregnancy outcomes (APO) in nulliparous pregnant persons. STUDY DESIGN Data were extracted from the 779 participants from a single nuMoM2b (Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be) study site, a prospective cohort study designed to identify contributors to APOs. Residential address information at delivery was linked to the location's COI. The overall composite and component scores in education, health and environmental, and socioeconomic indices were recorded. APOs of interest included preterm birth, hypertensive disorders of pregnancy, small for gestational age at birth, stillbirth, and gestational diabetes. Participant characteristics were compared by COI category and the association of COI with APOs was analyzed by logistic regression, controlling for age and self-reported race/ethnicity. RESULTS The overall COI distribution was very low (45%), low (17%), moderate (10%), high (15%), and very high (13%). A total of 329 (43.5%) participants experienced at least one APO. Overall COI was associated with developing an APO (p = 0.02). Each component score was also associated with developing APOs and with race/ethnicity (p < 0.05). Compared with higher COI categories, an overall low or very low categorized location was independently associated with developing an APO (odds ratio: 1.636, 95% confidence interval: 1.16-2.31). Adjusting for gestational age at birth, those in lower COI areas had newborns with lower birth weight, birth length, and head circumference (estimate [95% confidence interval] birth weight: -0.0005 g [-0.0008 to -0.0001]; length: -0.065 cm [-0.124 to -0.0091]; head circumference: -0.123 cm [-0.208 to -0.045]). COI was not associated with other newborn outcomes. CONCLUSION COI, a marker for social determinants of health, is independently associated with APOs. The COI may be a tool for risk stratification for pregnant people to help with APO-reducing strategies. KEY POINTS · The COI is a neighborhood-level marker for social determinants of health.. · The COI at time of delivery is associated with APO and newborn birth weight, length, and head circumference.. · The COI may be usable in pregnancy clinics to help identify resource needs to optimize outcomes for pregnant individuals and newborns..
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Affiliation(s)
- Olivia C Abraham
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alekhya Jampa
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sara K Quinney
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
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20
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Ronksley PE, Scory TD, McRae AD, MacRae JM, Manns BJ, Lang E, Donald M, Hemmelgarn BR, Elliott MJ. Emergency Department Use Among Adults Receiving Dialysis. JAMA Netw Open 2024; 7:e2413754. [PMID: 38809552 PMCID: PMC11137633 DOI: 10.1001/jamanetworkopen.2024.13754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/27/2024] [Indexed: 05/30/2024] Open
Abstract
Importance People with kidney failure receiving maintenance dialysis visit the emergency department (ED) 3 times per year on average, which is 3- to 8-fold more often than the general population. Little is known about the factors that contribute to potentially preventable ED use in this population. Objective To identify the clinical and sociodemographic factors associated with potentially preventable ED use among patients receiving maintenance dialysis. Design, Setting, and Participants This cohort study used linked administrative health data within the Alberta Kidney Disease Network to identify adults aged 18 years or older receiving maintenance dialysis (ie, hemodialysis or peritoneal dialysis) between April 1, 2010, and March 31, 2019. Patients who had been receiving dialysis for more than 90 days were followed up from cohort entry (defined as dialysis start date plus 90 days) until death, outmigration from the province, receipt of a kidney transplant, or end of study follow-up. The Andersen behavioral model of health services was used as a conceptual framework to identify variables related to health care need, predisposing factors, and enabling factors. Data were analyzed in March 2024. Main Outcomes and Measures Rates of all-cause ED encounters and potentially preventable ED use associated with 4 kidney disease-specific ambulatory care-sensitive conditions (hyperkalemia, heart failure, volume overload, and malignant hypertension) were calculated. Multivariable negative binomial regression models were used to examine the association between clinical and sociodemographic factors and rates of potentially preventable ED use. Results The cohort included 4925 adults (mean [SD] age, 60.8 [15.5] years; 3071 males [62.4%]) with kidney failure receiving maintenance hemodialysis (3183 patients) or peritoneal dialysis (1742 patients) who were followed up for a mean (SD) of 2.5 (2.0) years. In all, 3877 patients had 34 029 all-cause ED encounters (3100 [95% CI, 2996-3206] encounters per 1000 person-years). Of these, 755 patients (19.5%) had 1351 potentially preventable ED encounters (114 [95% CI, 105-124] encounters per 1000 person-years). Compared with patients with a nonpreventable ED encounter, patients with a potentially preventable ED encounter were more likely to be in the lowest income quintile (38.8% vs 30.9%; P < .001); to experience heart failure (46.8% vs 39.9%; P = .001), depression (36.6% vs 32.5%; P = .03), and chronic pain (60.1% vs 54.9%; P = .01); and to have a longer duration of dialysis (3.6 vs 2.6 years; P < .001). In multivariable regression analyses, potentially preventable ED use was higher for younger adults (incidence rate ratio [IRR], 1.69 [95% CI, 1.33-2.15] for those aged 18 to 44 years) and patients with chronic pain (IRR, 1.35 [95% CI, 1.14-1.61]), greater material deprivation (IRR, 1.57 [95% CI, 1.16-2.12]), a history of hyperkalemia (IRR, 1.31 [95% CI, 1.09-1.58]), and historically high ED use (ie, ≥3 ED encounters in the prior year; IRR, 1.46 [95% CI, 1.23-1.73). Conclusions and Relevance In this study of adults receiving maintenance dialysis in Alberta, Canada, among those with ED use, 1 in 5 had a potentially preventable ED encounter; reasons for such encounters were associated with both psychosocial and medical factors. The findings underscore the need for strategies that address social determinants of health to avert potentially preventable ED use in this population.
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Affiliation(s)
- Paul E. Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Tayler D. Scory
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew D. McRae
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer M. MacRae
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Braden J. Manns
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eddy Lang
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maoliosa Donald
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R. Hemmelgarn
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Meghan J. Elliott
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Wang AP, Griffith G, Otto-Meyer S, Ward K. The Child Opportunity Index 2.0 and Disparities in Pediatric Cardiorespiratory Fitness. J Pediatr 2024; 268:113964. [PMID: 38369240 DOI: 10.1016/j.jpeds.2024.113964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To evaluate the effect of neighborhood-level characteristics on cardiorespiratory fitness (CRF) via peak oxygen consumption (VO2peak) for healthy pediatric patients. STUDY DESIGN The institutional cardiopulmonary exercise testing (CPET) database was analyzed retrospectively. All patients aged ≤ 18 years without a diagnosis of cardiac disease and with a maximal effort CPET were included. Patients were divided into three self-identified racial categories: White, Black, and Latinx. The Child Opportunity Index (COI) 2.0 was used to analyze social determinants of health. CRF was evaluated based on COI quintiles and race. Assessment of the effect of COI on racial disparities in CRF was performed using ANCOVA. RESULTS A total of 1753 CPETs met inclusion criteria. The mean VO2peak was 42.1 ± 9.8 mL/kg/min. The VO2peak increased from 39.1 ± 9.6 mL/kg/min for patients in the very low opportunity cohort to 43.9 ± 9.4 mL/kg/min for patients in the very high opportunity cohort. White patients had higher percent predicted VO2peak compared with both Black and Latinx patients (P < .01 for both comparisons). The racial differences in CRF were no longer significant when adjusting for COI. CONCLUSION In a large pediatric cohort, COI was associated with CRF. Racial disparities in CRF are reduced when accounting for modifiable risk factors.
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Affiliation(s)
- Alan P Wang
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
| | - Garett Griffith
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL
| | - Sebastian Otto-Meyer
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Kendra Ward
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Shapiro DJ, Hall M, Ramgopal S, Alpern ER, Chaudhari PP, Eltorki M, Badaki-Makun O, Bergmann KR, Macy ML, Foster CC, Neuman MI. Acute care utilization for ambulatory care-sensitive conditions among publicly insured children. Acad Emerg Med 2024; 31:346-353. [PMID: 38385565 PMCID: PMC11014776 DOI: 10.1111/acem.14867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/01/2023] [Accepted: 12/27/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Although characteristics of preventable hospitalizations for ambulatory care-sensitive conditions (ACSCs) have been described, less is known about patterns of emergency and other acute care utilization for ACSCs among children who are not hospitalized. We sought to describe patterns of utilization for ACSCs according to the initial site of care and to determine characteristics associated with seeking initial care in an acute care setting rather than in an office. A better understanding of the sequence of health care utilization for ACSCs may inform efforts to shift care for these common conditions to the medical home. METHODS We performed a retrospective analysis of pediatric encounters for ACSCs between 2017 and 2019 using data from the IBM Watson MarketScan Medicaid database. The database includes insurance claims for Medicaid-insured children in 10 anonymized states. We assessed the initial sites of care for ACSC encounters, which were defined as either acute care settings (emergency or urgent care) or office-based settings. We used generalized estimating equations clustered on patient to identify associations between encounter characteristics and the initial site of care. RESULTS Among 7,128,515 encounters for ACSCs, acute care settings were the initial site of care in 27.9%. Diagnoses with the greatest proportion of episodes presenting to acute care settings were urinary tract infection (52.0% of episodes) and pneumonia (44.6%). Encounters on the weekend (adjusted odds ratio [aOR] 6.30, 95% confidence interval [CI] 6.27-6.34 compared with weekday) and among children with capitated insurance (aOR 1.55, 95% CI 1.54-1.56 compared with fee for service) were associated with increased odds of seeking care first in an acute care setting. CONCLUSIONS Acute care settings are the initial sites of care for more than one in four encounters for ACSCs among publicly insured children. Expanded access to primary care on weekends may shift care for ACSCs to the medical home.
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Affiliation(s)
- Daniel J Shapiro
- Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Sriram Ramgopal
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elizabeth R Alpern
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Mohamed Eltorki
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Oluwakemi Badaki-Makun
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Center for Data Science in Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kelly R Bergmann
- Department of Pediatric Emergency Medicine, Children's Hospital Minnesota, South Minneapolis, Minnesota, USA
| | - Michelle L Macy
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Carolyn C Foster
- Division of Advanced Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois, USA
| | - Mark I Neuman
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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23
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Kopczynski K, Casamassimo P, Amini H, Peng J, Gorham T, Meyer BD. Evaluating the type of pediatric dental care use in the context of neighborhood opportunity. J Am Dent Assoc 2024; 155:294-303.e4. [PMID: 38340112 DOI: 10.1016/j.adaj.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/26/2023] [Accepted: 11/16/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Increasing evidence supports the influence of neighborhood factors on health care use and outcomes. This study measured the association between area-level social determinants of health (SDH) and type of dental care use among Ohio pediatric Medicaid beneficiaries. METHODS A retrospective dental claims analysis was completed for children aged 1 through 5 years enrolled in Ohio Medicaid with a dental visit in 2017. Dental care use was measured from 2017 through 2021 as 1 of 4 visit types: (1) preventive, (2) caries treatment, (3) dental general anesthesia (GA), and (4) dental emergency department. The Ohio Children's Opportunity Index defined area-level SDH at the census tract level. Exploratory analysis included descriptive statistics of area-level SDH for each outcome. Poisson regression models were developed to examine the associations between the number of each dental care use outcome and Ohio Children's Opportunity Index quintiles. Visualizations were facilitated with geospatial mapping. RESULTS Fifty-six percent of children (10,008/17,675) had caries treatment visits. Overall area-level SDH were positively associated with preventive (fifth vs first quintile incidence rate ratio [IRR], 1.09; 95% CI, 1.07 to 1.12), caries treatment (fifth vs first quintile IRR, 1.16; 95% CI, 1.08 to 1.24), and dental GA visits (fifth vs first quintile IRR, 2.13; 95% CI, 1.13 to 4.01). CONCLUSIONS Children with preventive, caries treatment, and dental GA visits were more likely to live in neighborhoods with better SDH. Future efforts should investigate the mechanisms by which area-level factors influence dental access and use. PRACTICAL IMPLICATIONS Neighborhood factors influence pediatric dental care use. Patient home addresses might add value to caries risk assessment tools and efforts by care networks to optimize efficient care use.
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McCrory MC, Akande M, Slain KN, Kennedy CE, Winter MC, Stottlemyre MG, Wakeham MK, Barnack KA, Huang JX, Sharma M, Zurca AD, Pinto NP, Dziorny AC, Maddux AB, Garg A, Woodruff AG, Hartman ME, Timmons OD, Heidersbach RS, Cisco MJ, Sochet AA, Wells BJ, Halvorson EE, Saha AK. Child Opportunity Index and Pediatric Intensive Care Outcomes: A Multicenter Retrospective Study in the United States. Pediatr Crit Care Med 2024; 25:323-334. [PMID: 38088770 DOI: 10.1097/pcc.0000000000003427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To evaluate for associations between a child's neighborhood, as categorized by Child Opportunity Index (COI 2.0), and 1) PICU mortality, 2) severity of illness at PICU admission, and 3) PICU length of stay (LOS). DESIGN Retrospective cohort study. SETTING Fifteen PICUs in the United States. PATIENTS Children younger than 18 years admitted from 2019 to 2020, excluding those after cardiac procedures. Nationally-normed COI category (very low, low, moderate, high, very high) was determined for each admission by census tract, and clinical features were obtained from the Virtual Pediatric Systems LLC (Los Angeles, CA) data from each site. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among 33,901 index PICU admissions during the time period, median patient age was 4.9 years and PICU mortality was 2.1%. There was a higher percentage of admissions from the very low COI category (27.3%) than other COI categories (17.2-19.5%, p < 0.0001). Patient admissions from the high and very high COI categories had a lower median Pediatric Index of Mortality 3 risk of mortality (0.70) than those from the very low, low, and moderate COI groups (0.71) ( p < 0.001). PICU mortality was lowest in the very high (1.7%) and high (1.9%) COI groups and highest in the moderate group (2.5%), followed by very low (2.3%) and low (2.2%) ( p = 0.001 across categories). Median PICU LOS was between 1.37 and 1.50 days in all COI categories. Multivariable regression revealed adjusted odds of PICU mortality of 1.30 (95% CI, 0.94-1.79; p = 0.11) for children from a very low versus very high COI neighborhood, with an odds ratio [OR] of 0.996 (95% CI, 0.993-1.00; p = 0.05) for mortality for COI as an ordinal value from 0 to 100. Children without insurance coverage had an OR for mortality of 3.58 (95% CI, 2.46-5.20; p < 0.0001) as compared with those with commercial insurance. CONCLUSIONS Children admitted to a cohort of U.S. PICUs were often from very low COI neighborhoods. Children from very high COI neighborhoods had the lowest risk of mortality and observed mortality; however, odds of mortality were not statistically different by COI category in a multivariable model. Children without insurance coverage had significantly higher odds of PICU mortality regardless of neighborhood.
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Affiliation(s)
- Michael C McCrory
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Manzilat Akande
- Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, OK
| | - Katherine N Slain
- Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH
| | | | - Meredith C Winter
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | - Kyle A Barnack
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Jia Xin Huang
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA
| | - Meesha Sharma
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA
| | - Adrian D Zurca
- Pediatrics, Northwestern University Feinberg School of Medicine and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Neethi P Pinto
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Adam C Dziorny
- Pediatrics, University of Rochester School of Medicine, Rochester, NY
| | - Aline B Maddux
- Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Anjali Garg
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Charlotte Bloomberg Children's Center, Baltimore, MD
| | - Alan G Woodruff
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Mary E Hartman
- Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Otwell D Timmons
- Pediatrics, Atrium Health Levine Children's Hospital, Charlotte, NC
| | - R Scott Heidersbach
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Michael J Cisco
- Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA
| | - Anthony A Sochet
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Brian J Wells
- Department of Biostatistics and Data Science; Wake Forest University School of Medicine, Winston-Salem, NC
| | - Elizabeth E Halvorson
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Amit K Saha
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC
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Putnick DL, Bell EM, Tyris J, McAdam J, Ghassabian A, Mendola P, Sundaram R, Yeung E. Place-Based Child Opportunity at Birth and Child Development from Infancy to Age 4. J Pediatr 2024; 267:113909. [PMID: 38220066 PMCID: PMC10978256 DOI: 10.1016/j.jpeds.2024.113909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate whether the children's neighborhood quality, as a measure of place-based social determinants of health, is associated with the odds of developmental delay and developmental performance up to the age of 4 years. STUDY DESIGN Mothers of 5702 children from the Upstate KIDS Study, a longitudinal population-based cohort of children born from 2008 through 2010, provided questionnaire data and a subset of 573 children participated in a clinic visit. The Child Opportunity Index 2.0 was linked to home census tract at birth. Probable developmental delays were assessed by the Ages and Stages Questionnaire up to 7 times between 4 and 36 months, and developmental performance was assessed via the Battelle Developmental Inventory at the age of 4 years. RESULTS In unadjusted models, higher neighborhood opportunity was protective against developmental delays and was associated with slightly higher development scores at age 4. After adjusting for family-level confounding variables, 10-point higher Child Opportunity Index (on a 100-point scale) remained associated with a lower odds of any developmental delay (OR = .966, 95% CI = .940-.992), and specifically delays in the personal-social domain (OR = .921, 95% CI = .886-.958), as well as better development performance in motor (B = 0.79, 95% CI = 0.11-1.48), personal-social (B = 0.64, 95% CI = 0.003-1.28), and adaptive (B = 0.69, 95% CI = 0.04-1.34) domains at age 4. CONCLUSIONS Community-level opportunities are associated with some aspects of child development prior to school entry. Pediatric providers may find it helpful to use neighborhood quality as an indicator to inform targeted developmental screening.
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Affiliation(s)
- Diane L Putnick
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
| | - Erin M Bell
- Department of Environmental Health Sciences, University at Albany School of Public Health, Albany, NY
| | - Jordan Tyris
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD; Division of Hospital Medicine, Children's National Hospital, Washington, DC
| | - Jordan McAdam
- Department of Environmental Health Sciences, University at Albany School of Public Health, Albany, NY
| | - Akhgar Ghassabian
- Departments of Pediatrics, Environmental Medicine, and Population Health, New York University Grossman School of Medicine, New York, NY
| | - Pauline Mendola
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY
| | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Edwina Yeung
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
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26
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Song IG, Kim YS, Kim MS, Lee JW, Cho YM, Lim Y, Kwon SK, Suh DI, Park JD. Healthcare service use and medical outcomes of tracheostomy-dependent children: a nationwide study. BMJ Paediatr Open 2024; 8:e002377. [PMID: 38508660 PMCID: PMC10952918 DOI: 10.1136/bmjpo-2023-002377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/10/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Despite the rising trend of tracheostomies in children, there is a lack of comprehensive resources for families to navigate the challenges of living with a tracheostomy, emphasising the need for evidence-based support in understanding postoperative care and long-term adjustments. This study aimed to examine the pattern of using healthcare services and nationwide medical outcomes in children who underwent a tracheotomy before the age of 2 years. METHODS This retrospective study used the National Health Insurance System database from 2008 to 2016 and included all children codified with tracheotomy procedure codes before their second birthday. Healthcare utilisation, such as medical costs, number of hospital visits, home healthcare nursing and medical diagnoses on readmission, in the first 2 years after tracheotomy was evaluated. Multivariable logistic regression analysis was used to determine the factors affecting mortality. RESULTS In total, 813 patients were included in this study. Their use of healthcare services and the accompanying expenses were higher than the national medians for similar age groups; however, both metrics decreased in the second year. The major causes of admission within 2 years of surgery were respiratory and neurological diseases. The mortality rate within 2 years was 37.8%. Higher risks of mortality were associated with having two or more complex chronic conditions. Use of home healthcare nursing services was associated with a lower mortality risk. CONCLUSION Paediatric patients with more complex chronic conditions tended to have higher mortality rates within 2 years after surgery. However, receiving home healthcare nursing was significantly associated with a reduced risk of death. Many causes of hospitalisation may be preventable with education and supportive care. Therefore, further research for establishing an integrated care system for these patients and their caregivers is required.
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Affiliation(s)
- In Gyu Song
- Pediatrics, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
| | - You Sun Kim
- Department of Paediatrics, National Medical Center, Jung, Korea (the Republic of)
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Min Sun Kim
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
- Seoul National University Children's Hospital Integrated Care Center, Seoul, Korea (the Republic of)
| | - Ji Weon Lee
- Seoul National University Children's Hospital Integrated Care Center, Seoul, Korea (the Republic of)
| | - Yoon-Min Cho
- National Health Insurance Service, Wonju, Korea (the Republic of)
| | - Youna Lim
- Seoul National University, Gwanak-gu, Korea (the Republic of)
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Dong In Suh
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - June Dong Park
- Department of Paediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
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Beyer L, Keen R, Ertel KA, Okuzono SS, Pintro K, Delaney S, Slopen N. Comparing two measures of neighborhood quality and internalizing and externalizing behaviors in the adolescent brain cognitive development study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02614-4. [PMID: 38305870 DOI: 10.1007/s00127-024-02614-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/01/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE There is widespread recognition of the importance and complexity of measuring neighborhood contexts within research on child psychopathology. In this study, we assessed the cross-sectional associations between two measures of neighborhood quality and internalizing and externalizing behaviors in preadolescence. METHODS Drawing on baseline data from the Adolescent Brain Cognitive Development Study (n = 10,577 preadolescents), we examined two multi-component assessments of neighborhood quality in relation to children's internalizing and externalizing symptoms: the Area Deprivation Index (ADI), which measures socioeconomic adversity, and the Child Opportunity Index 2.0 (COI), which measures economic, educational, and environmental opportunity. Both measures were categorized into quintiles. We then used mixed-effects linear regression models to examine bivariate and adjusted associations. RESULTS The bivariate associations displayed strong inverse associations between the COI and ADI and externalizing symptoms, with a graded pattern of fewer externalizing behaviors with increasing neighborhood quality. Only the ADI was associated with externalizing behaviors in models adjusted for child and family characteristics. We did not observe a clear association between either measure of neighborhood quality and internalizing behaviors in bivariate or adjusted models. CONCLUSIONS Neighborhood quality, as measured by the COI and ADI, was associated with externalizing behaviors in preadolescent children. The association using the ADI persisted after adjustment for family-level characteristics, including financial strain. Our results indicate that different assessments of neighborhood quality display distinct associations with preadolescent behavioral health. Future research is needed to assess the association between neighborhood quality and behavior trajectories and to identify place-based intervention strategies.
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Affiliation(s)
- Logan Beyer
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA.
- Harvard Medical School, Boston, USA.
| | - Ryan Keen
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Karen A Ertel
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, USA
| | - Sakurako S Okuzono
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Kedie Pintro
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Scott Delaney
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, USA
- Center On the Developing Child, Harvard University, Boston, USA
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Carroll AR, Hall M, Noelke C, Ressler RW, Brown CM, Spencer KS, Bell DS, Williams DJ, Fritz CQ. Association of neighborhood opportunity and pediatric hospitalization rates in the United States. J Hosp Med 2024; 19:120-125. [PMID: 38073069 PMCID: PMC10872227 DOI: 10.1002/jhm.13252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 02/03/2024]
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.
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Affiliation(s)
- Alison R. Carroll
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | - Matt Hall
- Children’s Hospital Association, Lenexa, KS
| | - Clemens Noelke
- Heller School for Social Policy and Management, Brandeis University, Waltham, MS
| | - Robert W. Ressler
- Heller School for Social Policy and Management, Brandeis University, Waltham, MS
| | - Charlotte M. Brown
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | - Katherine S. Spencer
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | - Deanna S. Bell
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | - Derek J. Williams
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | - Cristin Q. Fritz
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
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Blatt LR, Sadler RC, Jones EJ, Miller P, Hunter-Rue DS, Votruba-Drzal E. Historical Structural Racism in the Built Environment and Contemporary Children's Opportunities. Pediatrics 2024; 153:e2023063230. [PMID: 38192230 DOI: 10.1542/peds.2023-063230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES There are well-documented links between structural racism and inequities in children's opportunities. Yet, when it comes to understanding the role of the built environment, a disproportionate focus on redlining obscures other historical policies and practices such as blockbusting, freeway displacement, and urban renewal that may impact contemporary child development. We hypothesized that historical structural racism in Allegheny County, Pennsylvania's, built environment would be associated with fewer contemporary educational, socioeconomic, and health opportunities. We also hypothesized that these measures would explain more collective variance in children's opportunities than redlining alone. METHODS We used geospatial data from the US Census, Mapping Inequality Project, and other archival sources to construct historical measures of redlining, blockbusting, freeway displacement, and urban renewal in ArcGIS at the census tract level. These were linked with data from the Child Opportunity Index 2.0 to measure children's opportunities across domains of education, socioeconomic status, and health. We ran spatial regression analyses in Stata 18.0 to examine individual and collective associations between structural racism and children's opportunities. RESULTS Historical redlining, blockbusting, and urban renewal were largely associated with fewer contemporary educational, socioeconomic, and health opportunities, and explained up to 47.4% of the variance in children's opportunities. The measures collectively explained more variance in children's opportunities than redlining alone. CONCLUSIONS In support of our hypotheses, novel measures of structural racism were related to present-day differences in children's opportunities. Findings lay the groundwork for future research focused on repairing longstanding harm perpetuated by structural racism.
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Tyris J, Gourishankar A, Kachroo N, Teach SJ, Parikh K. The Child Opportunity Index and asthma morbidity among children younger than 5 years old in Washington, DC. J Allergy Clin Immunol 2024; 153:103-110.e5. [PMID: 37877904 DOI: 10.1016/j.jaci.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Place-based social determinants of health are associated with pediatric asthma morbidity. However, there is little evidence on how social determinants of health correlate to the disproportionately high rates of asthma morbidity experienced by children <5 years old. OBJECTIVES This study sought to evaluate census tract associations between the Child Opportunity Index ±COI) and at-risk rates (ARRs) for pediatric asthma-related emergency department (ED) encounters and hospitalizations in Washington, DC. METHODS This was a cross-sectional study of children <5 years old with physician-diagnosed asthma included in the DC Asthma Registry between January 2018 and December 2019. Census tract COI score (1-100) and its 3 domains (social/economic, health/environmental, and educational) were the exposures (source: www.diversitydatakids.org). ED and hospitalization ARRs (outcomes) were created by dividing counts of ED encounters and hospitalizations by populations with asthma for each census tract and adjusted for population-level demographic (age, sex, insurance), clinical (asthma severity), and community (violent crime and limited English proficiency) covariates. RESULTS Within a study population of 3806 children with a mean age of 2.4 ± 1.4 years, 2132 (56%) had 5852 ED encounters, and 821 (22%) had 1418 hospitalizations. Greater census tract overall COI, social/economic COI, and educational COI were associated with fewer ED ARRs. There were no associations between the health/environmental COI and ED ARRs or between the COI and hospitalization ARRs. CONCLUSION Improving community-level social, economic, and educational opportunity within specific census tracts may reduce ED ARRs in this population.
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Affiliation(s)
- Jordan Tyris
- Children's National Hospital, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington.
| | - Anand Gourishankar
- Children's National Hospital, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington
| | - Nikita Kachroo
- Children's National Hospital, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington
| | - Stephen J Teach
- Children's National Hospital, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington
| | - Kavita Parikh
- Children's National Hospital, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington
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Das K, Onwuka AJ, Chisolm DJ. Social Determinants of Health Are Associated With Visits for Ambulatory Care Sensitive Conditions. Pediatr Emerg Care 2023; 39:934-939. [PMID: 37205847 DOI: 10.1097/pec.0000000000002971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Population health experts have described the link between social factors and health, but few studies link specific social needs to disease processes. Nationwide Children's Hospital implemented a universal, annual screener for social determinants of health (SDH) in 2018. Early analyses have shown that patients identifying an SDH need were more likely to have an emergency department (ED) or inpatient stay. The objective of this study is to identify links between SDH and ED presentation for ambulatory care sensitive conditions (ACSCs). METHODS This was a retrospective observational study of children aged 0-21 years receiving care at Nationwide Children's Hospital from 2018 to 2021 that were screened for SDH. Acute care utilization within 6 months of screener completion, sociodemographic, and clinical data were collected via EPIC data extraction. Patients that completed screening tool for the first time in the ED were excluded to minimize selection bias. Logistic regression was used to analyze the association between ED presentation for ACSCs and SDH needs. RESULTS A total of 108,346 social determinants screeners were included with 9% of screeners identifying a need. Five percent of the population expressed food needs, 4% transportation needs, 3% utility needs, and 1% housing needs. Eighteen percent of patients had an ED visit for ACSC, with the most common complaints being upper respiratory infections and asthma. Having any SDH need was associated with ED visits for ACSCs (odds ratio, 1.12; 95% confidence interval, 1.06-1.18). Needs in all domains were significantly associated with increased visits for ACSCs; however, patients with housing needs had the highest odds of utilization (odds ratio, 1.25; confidence interval, 1.11-1.41). CONCLUSIONS The odds of ED presentation for ACSCs are higher in patients with expressed social needs. Further delineating the connections between specific SDH and health outcomes can inform timely and appropriate interventions.
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Affiliation(s)
- Kristol Das
- From the Nationwide Children's Hospital, Columbus, OH
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Molloy MJ, Auger KA, Hall M, Shah SS, Schondelmeyer AC, Parikh K, Kazmier KM, Katragadda H, Jacob SA, Jerardi KE, Ivancie R, Hartley D, Bryan MA, Bhumbra S, Arnold SD, Brady PW. Epidemiology and Severity of Illness of MIS-C and Kawasaki Disease During the COVID-19 Pandemic. Pediatrics 2023; 152:e2023062101. [PMID: 37791428 PMCID: PMC10598633 DOI: 10.1542/peds.2023-062101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Multisystem inflammatory syndrome in children (MIS-C) is a novel, severe condition following severe acute respiratory syndrome coronavirus 2 infection. Large epidemiologic studies comparing MIS-C to Kawasaki disease (KD) and evaluating the evolving epidemiology of MIS-C over time are lacking. We sought to understand the illness severity of MIS-C compared with KD and evaluate changes in MIS-C illness severity over time during the coronavirus disease 2019 pandemic compared with KD. METHODS We included hospitalizations of children with MIS-C and KD from April 2020 to May 2022 from the Pediatric Health Information System administrative database. Our primary outcome measure was the presence of shock, defined as the use of vasoactive/inotropic cardiac support or extracorporeal membrane oxygenation. We examined the volume of MIS-C and KD hospitalizations and the proportion of hospitalizations with shock over time using 2-week intervals. We compared the proportion of hospitalizations with shock in MIS-C and KD patients over time using generalized estimating equations adjusting for hospital clustering and age, with time as a fixed effect. RESULTS We identified 4868 hospitalizations for MIS-C and 2387 hospitalizations for KD. There was a higher proportion of hospitalizations with shock in MIS-C compared with KD (38.7% vs 5.1%). In our models with time as a fixed effect, we observed a significant decrease in the odds of shock over time in MIS-C patients (odds ratio 0.98, P < .001) but not in KD patients (odds ratio 1.00, P = .062). CONCLUSIONS We provide further evidence that MIS-C is a distinct condition from KD. MIS-C was a source of lower morbidity as the pandemic progressed.
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Affiliation(s)
- Matthew J. Molloy
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Katherine A. Auger
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - Samir S. Shah
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Amanda C. Schondelmeyer
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Kavita Parikh
- Division of Hospital Medicine, Children’s National Hospital, and George Washington University School of Health Sciences, Washington, District of Columbia
| | | | - Harita Katragadda
- Division of Pediatric Hospital Medicine
- Department of Pediatrics, UT Southwestern, Dallas, Texas
| | | | - Karen E. Jerardi
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Rebecca Ivancie
- Department of Pediatrics, Stanford School of Medicine, Stanford, California
| | - David Hartley
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Mersine A. Bryan
- Department of Pediatrics, University of Washington, Seattle, Washington
- Seattle Children’s Research Institute, Seattle, Washington
| | - Samina Bhumbra
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Staci D. Arnold
- Department of Pediatrics, Emory University, Aflac Cancer and Blood Disorders Center at Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Patrick W. Brady
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital, Cincinnati, Ohio
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Shanahan KH, James P, Rifas-Shiman SL, Gold DR, Oken E, Aris IM. Neighborhood Conditions and Resources in Mid-Childhood and Dampness and Pests at Home in Adolescence. J Pediatr 2023; 262:113625. [PMID: 37463640 PMCID: PMC10789911 DOI: 10.1016/j.jpeds.2023.113625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/05/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To examine prospectively associations of neighborhood opportunity with the presence of dampness or pests in the home environment during early adolescence. STUDY DESIGN We geocoded residential addresses from 831 children (mean age 7.9 years, 2007-2011) in the Project Viva cohort. We linked each address with census tract-level Child Opportunity Index scores, which capture neighborhood conditions and resources influencing child heath including educational, health, environmental, and socioeconomic factors. Our primary outcome was presence of dampness or pests in the home in early adolescence (mean age 13.2 years, 2013-2016). Secondary outcomes included current asthma and lung function testing results. Mixed-effects regression models estimated longitudinal associations of Child Opportunity Index scores with outcomes, adjusting for individual and family sociodemographics. RESULTS Children residing in neighborhoods with greater overall opportunity were less likely to live in homes with dampness or pests approximately 5 years later (aOR 0.85 per 20-unit increase in Child Opportunity Index percentile rank, 95% CI 0.73-0.998). We observed no significant associations in adjusted models of overall neighborhood opportunity with current asthma or lung function. Lower school poverty or single-parent households and greater access to healthy food or economic resource index were associated with lower odds of a home environment with dampness or pests. CONCLUSIONS More favorable neighborhood conditions in mid-childhood were associated with lower likelihood of living in a home with dampness or pests in the early adolescence.
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Affiliation(s)
- Kristen H Shanahan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA.
| | - Peter James
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard University and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard University and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Diane R Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard University and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard University and Harvard Pilgrim Health Care Institute, Boston, MA
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Lang S, Silveira L, Smith C, Abuogi L, DeCamp LR. Variation over Time in Child and Neighborhood Characteristics Associated with COVID-19. Health Equity 2023; 7:676-684. [PMID: 37908402 PMCID: PMC10615088 DOI: 10.1089/heq.2022.0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 11/02/2023] Open
Abstract
Introduction To examine the associations between child and neighborhood characteristics and incidence of COVID-19 infection during the first 19 months of the pandemic. Study Design We utilized individual electronic health record data and corresponding census tract characteristics for pediatric SARS-CoV-2 cases (age <18 years) from March 23, 2020 to September 30, 2021 with molecular tests resulted at a children's health system in Colorado. We compared associations between individual SARS-CoV-2 cases and census tract SARS-CoV-2 positivity rates over three time periods (TP1: March-September 2020; TP2: October 2020-March 2021; TP3: April-September 2021) using multinomial logistic regression for individual associations and negative binomial regression for census tract associations. Results We included 7498 pediatric SARS-CoV-2 cases and data from 711 corresponding census tracts. Spanish preferred health care language was associated with SARS-CoV-2 positivity for TP1 (odds ratio [OR] 4.9, 95% confidence interval [CI] 3.7-6.5) and TP2 (OR 2.01, 95% CI 1.6-2.6) compared with TP3. Other non-English preferred health care language was associated with SARS-CoV-2 positivity in TP1 (OR 2.4, 95% CI 1.4-4.2). Increasing percentage internationally born in a census tract was associated with SARS-CoV-2 positivity for TP1 (multivariable incident rate ratio [IRR]=1.040, p<0.0001), TP2 (multivariable IRR=1.028, p<0.0001), and in all TP combined (multivariable IRR=1.024, p<0.0001). Discussion Our study is notable for the identification of COVID-19 disparities among children in immigrant families and communities, particularly early in the pandemic. Addressing disparities for immigrant communities requires targeted investments in public health infrastructure.
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Affiliation(s)
- Sean Lang
- Department of Pediatrics, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Children's Hospital Immunodeficiency Program (CHiP), Children's Hospital Colorado, Aurora, Colorado, USA
| | - Lori Silveira
- Department of Pediatrics, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Christiana Smith
- Department of Pediatrics, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Children's Hospital Immunodeficiency Program (CHiP), Children's Hospital Colorado, Aurora, Colorado, USA
| | - Lisa Abuogi
- Department of Pediatrics, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Children's Hospital Immunodeficiency Program (CHiP), Children's Hospital Colorado, Aurora, Colorado, USA
| | - Lisa Ross DeCamp
- Department of Pediatrics, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), Aurora, Colorado, USA
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Goulding M, Ryan G, Frisard C, Stevens EM, Person S, Goldberg R, Garg A, Lemon SC. Disparities in Receipt of Guideline-adherent Blood Pressure Screening: An Observational Examination of Electronic Health Record Data from a Massachusetts Healthcare System. J Pediatr 2023; 261:113592. [PMID: 37399919 PMCID: PMC10530438 DOI: 10.1016/j.jpeds.2023.113592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To describe the prevalence of blood pressure (BP) screening according to the 2017 American Academy of Pediatrics (AAP) guidelines and differences according to social vulnerability indicators. STUDY DESIGN We extracted electronic health record data from January 1, 2018, through December 31, 2018, from the largest healthcare system in Central Massachusetts. Outpatient visits for children aged 3-17 years without a prior hypertension diagnosis were included. Adherence was defined by the American Academy of Pediatrics guideline (≥1 BP screening for children with a body mass index [BMI] of <95th percentile) and at every encounter for children with a BMI of ≥95th percentile). Independent variables included social vulnerability indicators at the patient level (insurance type, language, Child Opportunity Index, race/ethnicity) and clinic level (location, Medicaid population). Covariates included child's age, sex, and BMI status, and clinic specialty, patient panel size, and number of healthcare providers. We used direct estimation to calculate prevalence estimates and multivariable mixed effects logistic regression to determine the odds of receiving guideline-adherent BP screening. RESULTS Our sample comprised 19 695 children (median age, 11 years; 48% female) from 7 pediatric and 20 family medicine clinics. The prevalence of guideline-adherent BP screening was 89%. In our adjusted model, children with a BMI of ≥95th percentile, with public insurance, and who were patients at clinics with larger Medicaid populations and larger patient panels had a lower odds of receiving guideline-adherent BP screening. CONCLUSIONS Despite overall high adherence to BP screening guidelines, patient- and clinic-level disparities were identified.
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Affiliation(s)
- Melissa Goulding
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA.
| | - Grace Ryan
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
| | - Christine Frisard
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
| | - Elise M Stevens
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
| | - Sharina Person
- Division of Biostatistics and Health Service Research, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
| | - Robert Goldberg
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
| | - Arvin Garg
- Department of Pediatrics, Child Health Equity Center, University of Massachusetts Chan Medical School, UMass Memorial Children's Medical Center, Worcester, MA
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
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Slopen N, Umaña-Taylor AJ, Shonkoff JP, Carle AC, Hatzenbuehler ML. State-Level Anti-Immigrant Sentiment and Policies and Health Risks in US Latino Children. Pediatrics 2023; 152:e2022057581. [PMID: 37581234 PMCID: PMC10565791 DOI: 10.1542/peds.2022-057581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Although systemic inequities, broadly defined, are associated with health disparities in adults, there is a dearth of research linking contextual measures of exclusionary policies or prejudicial attitudes to health impairments in children, particularly among Latino populations. In this study, we examined a composite measure of systemic inequities in relation to the cooccurrence of multiple health problems in Latino children in the United States. METHODS Participants included 17 855 Latino children aged 3 to 17 years from the National Survey of Children's Health (2016-2020). We measured state-level systemic inequities using a factor score that combined an index of exclusionary state policies toward immigrants and aggregated survey data on prejudicial attitudes toward immigrants and Latino individuals. Caregivers reported on 3 categories of child health problems: common health difficulties in the past year, current chronic physical health conditions, and current mental health conditions. For each category, we constructed a variable reflecting 0, 1, or 2 or more conditions. RESULTS In models adjusted for sociodemographic covariates, interpersonal discrimination, and state-level income inequality, systemic inequities were associated with 1.13 times the odds of a chronic physical health condition (95% confidence interval: 1.02-1.25) and 1.24 times the odds of 2 or more mental health conditions (95% confidence interval: 1.06-1.45). CONCLUSIONS Latino children residing in states with higher levels of systemic inequity are more likely to experience mental health or chronic physical health conditions relative to those in states with lower levels of systemic inequity.
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Affiliation(s)
- Natalie Slopen
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Center on the Developing Child
| | | | - Jack P. Shonkoff
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Center on the Developing Child
- Harvard Graduate School of Education, Harvard University, Cambridge, Massachusetts
- Harvard Medical School and Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Adam C. Carle
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Psychology University of Cincinnati College of Arts and Sciences
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Markham JL, Richardson T, Stephens JR, Gay JC, Hall M. Essential Concepts for Reducing Bias in Observational Studies. Hosp Pediatr 2023; 13:e234-e239. [PMID: 37416975 PMCID: PMC10527895 DOI: 10.1542/hpeds.2023-007116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Randomized controlled trials (RCTs) are the gold standard study design for clinical research, as prospective randomization, at least in theory, balances any differences that can exist between groups (including any differences not measured as part of the study) and isolates the studied treatment effect. Any remaining imbalances after randomization are attributable to chance. However, there are many barriers to conducting RCTs within pediatric populations, including lower disease prevalence, high costs, inadequate funding, and additional regulatory requirements. Researchers thus frequently use observational study designs to address many research questions. Observational studies, whether prospective or retrospective, do not involve randomization and thus have more potential for bias when compared with RCTs because of imbalances that can exist between comparison groups. If these imbalances are associated with both the exposure of interest and the outcome, then failure to account for these imbalances may result in a biased conclusion. Understanding and addressing differences in sociodemographic and/or clinical characteristics within observational studies are thus necessary to reduce bias. Within this Method/ology submission we describe techniques to minimize bias by controlling for important measurable covariates within observational studies and discuss the challenges and opportunities in addressing specific variables.
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Affiliation(s)
- Jessica L. Markham
- Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri Kansas City, Kansas City, Missouri
- Department of Pediatrics, The University of Kansas, Kansas City, Kansas
| | | | - John R. Stephens
- Department of Medicine, North Carolina Children’s Hospital, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - James C. Gay
- Department of Pediatrics, Vanderbilt University School of Medicine, Monroe Carrell, Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Matt Hall
- Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri Kansas City, Kansas City, Missouri
- Children’s Hospital Association, Lenexa, Kansas
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Ramachandran J, Mayne SL, Kelly MK, Powell M, McPeak KE, Dalembert G, Jenssen BP, Fiks AG. Measures of Neighborhood Opportunity and Adherence to Recommended Pediatric Primary Care. JAMA Netw Open 2023; 6:e2330784. [PMID: 37615987 PMCID: PMC10450570 DOI: 10.1001/jamanetworkopen.2023.30784] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023] Open
Abstract
Importance Neighborhood conditions are known to broadly impact child health. Research to date has not examined the association of the Childhood Opportunity Index (COI), a multidimensional indicator of neighborhood environment conditions, specifically with pediatric primary care outcomes. Objective To determine the association of neighborhood opportunity measured by the COI with health metrics commonly captured clinically in pediatric primary care, reflecting both access to preventive care and child well-being. Design, Setting, and Participants This cross-sectional observational study used electronic health record data from a large pediatric primary care network in the northeastern US. Participants included patients aged 0 to 19 years who were active in the primary care network between November 2020 and November 2022. Data were analyzed in December 2022. Exposure Census tract-level COI overall score (in quintiles). Main Outcomes and Measures Outcomes included up-to-date preventive care and immunization status and presence of obesity, adolescent depression and suicidality, and maternal depression and suicidality. Multivariable mixed-effects logistic regressions estimated associations of these outcomes with COI quintiles, adjusted for age, sex, race and ethnicity, and insurance type. Results Among 338 277 patients (mean [SD] age, 9.8 [5.9] years; 165 223 female [48.8%]; 158 054 [46.7%] non-Hispanic White, 209 482 [61.9%] commercially insured), 81 739 (24.2%) and 130 361 (38.5%) lived in neighborhoods of very low and very high COI, respectively. Living in very high COI neighborhoods (vs very low COI) was associated with higher odds of being up-to-date on preventive visits (odds ratio [OR], 1.40; 95% CI, 1.32-1.48) and immunizations (OR, 1.77; 95% CI, 1.58-2.00), and with lower odds of obesity (OR, 0.55; 95% CI, 0.52-0.58), adolescent depression (OR, 0.78; 95% CI, 0.72-0.84) and suicidality (OR, 0.79; 95% CI, 0.73-0.85), and maternal depression (OR, 0.78; 95% CI, 0.72-0.86) and suicidality (OR, 0.71; 95% CI, 0.61-0.83). Conclusions and Relevance This cross-sectional study of electronic health record data found that neighborhood opportunity was associated with multiple pediatric primary care outcomes. Understanding these associations can help health systems identify neighborhoods that need additional support and advocate for and develop partnerships with community groups to promote child well-being. The findings underscore the importance of improving access to preventive care in low COI communities.
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Affiliation(s)
- Janani Ramachandran
- Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Possibilities Project, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephanie L. Mayne
- Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Possibilities Project, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
| | - Mary Kate Kelly
- Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Possibilities Project, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Maura Powell
- Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Possibilities Project, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Katie E. McPeak
- Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Possibilities Project, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - George Dalembert
- Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Possibilities Project, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
| | - Brian P. Jenssen
- Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Possibilities Project, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
| | - Alexander G. Fiks
- Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Possibilities Project, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
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Mayourian J, Brown E, Javalkar K, Bucholz E, Gauvreau K, Beroukhim R, Feins E, Kheir J, Triedman J, Dionne A. Insight into the Role of the Child Opportunity Index on Surgical Outcomes in Congenital Heart Disease. J Pediatr 2023; 259:113464. [PMID: 37172810 DOI: 10.1016/j.jpeds.2023.113464] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/20/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To use neighborhood-level Child Opportunity Index (COI) measures to investigate disparities in congenital heart surgery postoperative outcomes and identify potential targets for intervention. STUDY DESIGN In this single-institution retrospective cohort study, children <18 years old who underwent cardiac surgery between 2010 and 2020 were included. Patient-level demographics and neighborhood-level COI were used as predictor variables. COI-a composite US census tract-based score measuring educational, health/environmental, and social/economic opportunities-was dichotomized as lower (<40th percentile) vs higher (≥40th percentile). Cumulative incidence of hospital discharge was compared between groups using death as a competing risk, adjusting for clinical characteristics associated with outcomes. Secondary outcomes included hospital readmission and death within 30 days. RESULTS Among 6247 patients (55% male) with a median age of 0.8 years (IQR, 0.2-4.3), 26% had lower COI. Lower COI was associated with longer hospital lengths of stay (adjusted HR, 1.2; 95% CI, 1.1-1.2; P < .001) and an increased risk of death (adjusted OR, 2.0; 95% CI. 1.4-2.8; P < .001), but not hospital readmission (P = .6). At the neighborhood level, lacking health insurance coverage, food/housing insecurity, lower parental literacy and college attainment, and lower socioeconomic status were associated with longer hospital length of stay and increased risk of death. At the patient-level, public insurance (adjusted OR, 1.4; 95% CI, 1.0-2.0; P = .03) and caretaker Spanish language (adjusted OR 2.4; 95% CI, 1.2-4.3; P < .01) were associated with an increased risk of death. CONCLUSIONS Lower COI is associated with longer length of stay and higher early postoperative mortality. Risk factors identified including Spanish language, food/housing insecurity, and parental literacy serve as potential intervention targets.
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Affiliation(s)
- Joshua Mayourian
- Department of Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Pediatrics, Boston University, Boston, MA
| | - Ella Brown
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Karina Javalkar
- Department of Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Pediatrics, Boston University, Boston, MA
| | - Emily Bucholz
- Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Kimberlee Gauvreau
- Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Rebecca Beroukhim
- Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Eric Feins
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA
| | - John Kheir
- Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - John Triedman
- Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Audrey Dionne
- Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital, Boston, MA.
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Zolotor A, Huang RW, Bhavsar NA, Cholera R. Quantifying Associations Between Child Health and Neighborhood Social Vulnerability: Does the Choice of Index Matter? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.20.23291679. [PMID: 37461577 PMCID: PMC10350141 DOI: 10.1101/2023.06.20.23291679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Importance Policymakers have increasingly utilized place-based social disadvantage indices to quantify the impacts of place on health and inform equitable resource allocation. Indices vary in design, content, and purpose but are often used interchangeably, potentially resulting in differential assignments of relative disadvantage depending on index choice. Objective To compare associations between three commonly used disadvantage indices (Social Vulnerability Index (SVI), Area Deprivation Index (ADI), and Child Opportunity Index (COI)) and two epidemiologically distinct child health outcomes-infant well-child check (WCC) attendance and adolescent obesity. Design Cross-sectional analysis of Duke University Health System electronic health record (EHR) data from January 2014 to December 2019. Participants Children ≤18 years of age with outpatient encounters between January 2014 and December 2019, and who were Durham County residents were eligible. WCC attendance was assessed for infants ages 0-15 months; obesity was assessed for children ages 11-17 years. Exposures 2014 Social Vulnerability Index (SVI), 2015 Area Deprivation Index (ADI), and 2015 Child Opportunity Index (COI) 2.0. Main Outcomes 1) Infant WCC attendance: attending less than the minimum recommended six WCCs in the first 15 months of life, and 2) Adolescent obesity: BMI ≥ the 95th percentile at both the most recent encounter and an encounter within the prior 9-36 months. Results Of 10175 patients in the WCC cohort, 20% (n = 2073) had less than six WCCs. Of 14961 patients in the obesity cohort, 20% (n = 2933) had obesity. All three indices were associated with both WCCs (OR for SVI 1.10, 95% CI 1.08-1.12; OR for ADI 1.10, 95% CI 1.08-1.12; OR for COI 1.12, 95% CI 1.10-1.14) and obesity (OR for SVI 1.05, 95% CI 1.04-1.08; OR for ADI 1.08, 95% CI 1.06-1.10; OR for COI 1.07, 95% CI 1.05-1.08). Conclusions and relevance Higher social disadvantage as defined by all three indices was similarly associated with both adolescent obesity and decreased infant WCC attendance. While the COI incorporates a broader set of child-specific variables, the SVI and ADI may often be just as suitable for pediatric research. Users should consider population and outcome characteristics when selecting an index.
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Affiliation(s)
- Anna Zolotor
- Trinity College of Arts & Sciences, Duke University
- Duke-Margolis Center for Health Policy
| | - Ro W. Huang
- Trinity College of Arts & Sciences, Duke University
- Duke-Margolis Center for Health Policy
| | - Nrupen A. Bhavsar
- Duke University School of Medicine (DUSM) Department of Surgery
- DUSM Department of Biostatistics and Bioinformatics and Bioinformatics
| | - Rushina Cholera
- Duke-Margolis Center for Health Policy
- DUSM Department of Population Health Sciences
- DUSM Department of Pediatrics
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Attridge MM, Heneghan JA, Akande M, Ramgopal S. Association of Pediatric Mortality With the Child Opportunity Index Among Children Presenting to the Emergency Department. Acad Pediatr 2023; 23:980-987. [PMID: 36682452 DOI: 10.1016/j.acap.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Child health and development is influenced by neighborhood context. The Child Opportunity Index (COI) is a multidimensional measure of neighborhood conditions. We sought to evaluate the association of COI with mortality among children presenting to the emergency department (ED). METHODS We performed a multicenter cross-sectional study of pediatric (<18 years) ED encounters from a statewide dataset from 2016 to 2020. We constructed a multivariable logistic regression model to evaluate the association between COI and in-hospital mortality after adjusting for sociodemographic characteristics and medical complexity. RESULTS Among 4,653,070 included encounters, in-hospital mortality occurred in 1855 (0.04%). There was a higher proportion of encounters with mortality in the lower COI categories relative to the higher COI categories (0.053%, 0.038%, 0.031%, 0.034%, 0.034% ranging from Very Low to Very High, respectively). In adjusted models, child residence in Low (adjusted odds ratio 1.26; 95% confidence interval [CI], 1.04-1.53) and Very Low (adjusted odds ratio 1.58; 95% CI, 1.31-1.90) COI neighborhoods was associated with mortality relative to residence in Very High COI neighborhoods. This association was noted across all domains of COI (education, health and environment, and social and economic), using an expanded definition of mortality, using nationally normed COI, and excluding patients with complex chronic conditions. Other factors associated with increased odds of mortality included age, medical complexity, payor status, age, and race and ethnicity. CONCLUSIONS Understanding the association of neighborhood context on child mortality can inform public health interventions to improve child mortality rates and reduce disparities.
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Affiliation(s)
- Megan M Attridge
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine (MM Attridge and S Ramgopal), Chicago, Ill.
| | - Julia A Heneghan
- Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital; University of Minnesota (JA Heneghan), Minneapolis, Minn
| | - Manzilat Akande
- Section of Pediatric Critical Care, Oklahoma University Health Sciences Center (M Akande), Oklahoma City, Okla
| | - Sriram Ramgopal
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine (MM Attridge and S Ramgopal), Chicago, Ill
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Akande MY, Ramgopal S, Graham RJ, Goodman DM, Heneghan JA. Child Opportunity Index and Emergent PICU Readmissions: A Retrospective, Cross-Sectional Study of 43 U.S. Hospitals. Pediatr Crit Care Med 2023; 24:e213-e223. [PMID: 36897092 DOI: 10.1097/pcc.0000000000003191] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVES To examine the association between a validated composite measure of neighborhood factors, the Child Opportunity Index (COI), and emergent PICU readmission during the year following discharge for survivors of pediatric critical illness. DESIGN Retrospective cross-sectional study. SETTING Forty-three U.S. children's hospitals contributing to the Pediatric Health Information System administrative dataset. PATIENTS Children (< 18 yr) with at least one emergent PICU admission in 2018-2019 who survived an index admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 78,839 patients, 26% resided in very low COI neighborhoods, 21% in low COI, 19% in moderate COI, 17% in high COI, and 17% in very high COI neighborhoods, and 12.6% had an emergent PICU readmission within 1 year. After adjusting for patient-level demographic and clinical factors, residence in neighborhoods with moderate, low, and very low COI was associated with increased odds of emergent 1-year PICU readmission relative to patients in very high COI neighborhoods. Lower COI levels were associated with readmission in diabetic ketoacidosis and asthma. We failed to find an association between COI and emergent PICU readmission in patients with an index PICU admission diagnosis of respiratory conditions, sepsis, or trauma. CONCLUSIONS Children living in neighborhoods with lower child opportunity had an increased risk of emergent 1-year readmission to the PICU, particularly children with chronic conditions such as asthma and diabetes. Assessing the neighborhood context to which children return following critical illness may inform community-level initiatives to foster recovery and reduce the risk of adverse outcomes.
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Affiliation(s)
- Manzilat Y Akande
- Section of Critical Care, Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, OK
| | - Sriram Ramgopal
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert J Graham
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Denise M Goodman
- Division of Pediatric Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Julia A Heneghan
- Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital; University of Minnesota, Minneapolis, MN
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Ming DY, Zhao C, Tang X, Chung RJ, Rogers UA, Stirling A, Economou-Zavlanos NJ, Goldstein BA. Predictive Modeling to Identify Children With Complex Health Needs At Risk for Hospitalization. Hosp Pediatr 2023; 13:357-369. [PMID: 37092278 PMCID: PMC10158078 DOI: 10.1542/hpeds.2022-006861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Identifying children at high risk with complex health needs (CCHN) who have intersecting medical and social needs is challenging. This study's objectives were to (1) develop and evaluate an electronic health record (EHR)-based clinical predictive model ("model") for identifying high-risk CCHN and (2) compare the model's performance as a clinical decision support (CDS) to other CDS tools available for identifying high-risk CCHN. METHODS This retrospective cohort study included children aged 0 to 20 years with established care within a single health system. The model development/validation cohort included 33 months (January 1, 2016-September 30, 2018) and the testing cohort included 18 months (October 1, 2018-March 31, 2020) of EHR data. Machine learning methods generated a model that predicted probability (0%-100%) for hospitalization within 6 months. Model performance measures included sensitivity, positive predictive value, area under receiver-operator curve, and area under precision-recall curve. Three CDS rules for identifying high-risk CCHN were compared: (1) hospitalization probability ≥10% (model-predicted); (2) complex chronic disease classification (using Pediatric Medical Complexity Algorithm [PMCA]); and (3) previous high hospital utilization. RESULTS Model development and testing cohorts included 116 799 and 27 087 patients, respectively. The model demonstrated area under receiver-operator curve = 0.79 and area under precision-recall curve = 0.13. PMCA had the highest sensitivity (52.4%) and classified the most children as high risk (17.3%). Positive predictive value of the model-based CDS rule (19%) was higher than CDS based on the PMCA (1.9%) and previous hospital utilization (15%). CONCLUSIONS A novel EHR-based predictive model was developed and validated as a population-level CDS tool for identifying CCHN at high risk for future hospitalization.
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Affiliation(s)
- David Y. Ming
- Departments of Pediatrics
- Medicine
- Population Health Sciences
| | | | - Xinghong Tang
- Janssen Research & Development, LLC, Raritan, New Jersey
| | | | - Ursula A. Rogers
- Duke AI Health, Duke University School of Medicine, Durham, North Carolina
| | - Andrew Stirling
- Duke AI Health, Duke University School of Medicine, Durham, North Carolina
| | | | - Benjamin A. Goldstein
- Departments of Pediatrics
- Population Health Sciences
- Biostatistics & Bioinformatics, and
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Akande M, Paquette ET, Magee P, Perry-Eaddy MA, Fink EL, Slain KN. Screening for Social Determinants of Health in the Pediatric Intensive Care Unit: Recommendations for Clinicians. Crit Care Clin 2023; 39:341-355. [PMID: 36898778 PMCID: PMC10332174 DOI: 10.1016/j.ccc.2022.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Social determinants of health (SDoH) play a significant role in the health and well-being of children in the United States. Disparities in the risk and outcomes of critical illness have been extensively documented but are yet to be fully explored through the lens of SDoH. In this review, we provide justification for routine SDoH screening as a critical first step toward understanding the causes of, and effectively addressing health disparities affecting critically ill children. Second, we summarize important aspects of SDoH screening that need to be considered before implementing this practice in the pediatric critical care setting.
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Affiliation(s)
- Manzilat Akande
- Section of Critical Care, Department of Pediatrics, Oklahoma University Health Sciences Center, OU Children's Physicians Building, 1200 Children's Avenue, Oklahoma City, OK 73104, USA.
| | - Erin T Paquette
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East, Chicago Avenue, Box 73, Chicago, IL 60611, USA
| | - Paula Magee
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East, Chicago Avenue, Box 73, Chicago, IL 60611, USA
| | - Mallory A Perry-Eaddy
- University of Connecticut School of Nursing, 231 Glenbrook Rd, U-4026, Storrs, CT 06269, USA; Department of Pediatrics, University of Connecticut School of Medicine, 200 Academic Way, Farmington, CT 06032, USA
| | - Ericka L Fink
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 2nd floor, Pittsburgh, PA 15206, USA
| | - Katherine N Slain
- Division of Pediatric Critical Care Medicine, University Hospitals Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, RBC 6010 Cleveland, OH 44106, USA; Department of Pediatrics, Case Western Reserve University School of Medicine, 9501 Euclid Avenue, Cleveland, OH 44106, USA
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Hospitalizations at United States Children's Hospitals and Severity of Illness by Neighborhood Child Opportunity Index. J Pediatr 2023; 254:83-90.e8. [PMID: 36270394 DOI: 10.1016/j.jpeds.2022.10.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/13/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the association between neighborhood opportunity measured by the Child Opportunity Index 2.0 (COI) and patterns of hospital admissions and disease severity among children admitted to US pediatric hospitals. STUDY DESIGN Retrospective, cross-sectional study of 773 743 encounters for children <18 years of age admitted to US children's hospitals participating in the Pediatric Health Information System database 7/2020-12/2021. RESULTS The proportion of children from each COI quintile was inversely related to the degree of neighborhood opportunity. The difference between the proportion of patients from Very Low COI and Very High COI ranged from +32.0% (type 2 diabetes mellitus with complications) to -14.1% (mood disorders). The most common principal diagnoses were acute bronchiolitis, respiratory failure/insufficiency, chemotherapy, and asthma. Of the 45 diagnoses which occurred in ≥0.5% of the cohort, 22, including type 2 diabetes mellitus, asthma, and sleep apnea had higher odds of occurring in lower COI tiers in multivariable analysis. Ten diagnoses, including mood disorders, neutropenia, and suicide and intentional self-inflicted injury had lower odds of occurring in the lower COI tiers. The proportion of patients needing critical care and who died increased, as neighborhood opportunity decreased. CONCLUSIONS Pediatric hospital admission diagnoses and severity of illness are disproportionately distributed across the range of neighborhood opportunity, and these differences persist after adjustment for factors including race/ethnicity and payor status, suggesting that these patterns in admissions reflect disparities in neighborhood resources and differential access to care.
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Straus AM, Hayes A, Simon J, Sims A, Skerlong K, Wilmoth M, Bigham MT. Evaluating Demographic Data to Improve Confidence in Equity Analytics in a Children's Hospital. Pediatr Qual Saf 2023; 8:e642. [PMID: 37051408 PMCID: PMC10085515 DOI: 10.1097/pq9.0000000000000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 02/20/2023] [Indexed: 04/14/2023] Open
Abstract
Healthcare institutions are placing greater emphasis on equitable care. To accurately track and validate equity metrics, Akron Children's Hospital evaluated how key fields are collected, analyzed, and visualized throughout the organization. Standardized recommendations in this area vary, and this investigation provided specific ways to advance analytics in this field. In addition, the technical infrastructure needed a comprehensive evaluation to increase confidence in using demographic data. Methods First, we reviewed how staff are trained to collect data at registration. Next, the electronic health record team standardized race and ethnicity fields with federal definitions. We found that fields were not consistently accessible across reporting tools. However, when present, all fields are sourced from the same electronic health record field. Finally, 6 months of encounters were analyzed and validated, with limitations to a seldom-populated Race 2 field. Results We compared data, including and excluding null values, to provide concise recommendations for standard visualizations. We uncovered many consistencies and a few inconsistencies that informed the next steps. Conclusions The results informed 7 recommendations to align Akron Children's Hospital's advancement in analytics for health equity data: standardize race and ethnicity fields across all reporting tools, add Child Opportunity Index 2.0 to the enterprise data warehouse, utilize data at the time of the patient's encounter, include null fields (patient refused, unknown, and not specified) in analysis, increase reporting capabilities for social determinants of health (SDOH), standardize multiracial data visualizations, and optimize reliable upstream data collection to increase reliability for all health equity measures.
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Affiliation(s)
- Anna M. Straus
- From the Enterprise Data and Analytics Department, Akron Children’s Hospital, Akron, Ohio
| | - Alissa Hayes
- Patient Experience Department, Akron Children’s Hospital, Akron, Ohio
| | - Jodi Simon
- Quality Services Department, Akron Children’s Hospital, Akron, Ohio
| | - Andrea Sims
- Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio
| | - Karen Skerlong
- Quality Services Department, Akron Children’s Hospital, Akron, Ohio
| | - Michele Wilmoth
- School Health Services Department, Akron Children’s Hospital, Akron, Ohio
| | - Michael T. Bigham
- Patient Experience Department, Akron Children’s Hospital, Akron, Ohio
- Quality Services Department, Akron Children’s Hospital, Akron, Ohio
- Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio
- Department of Pediatrics, Northeast Ohio Medical University, Rootstown, Ohio
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Lou S, Giorgi S, Liu T, Eichstaedt JC, Curtis B. Measuring disadvantage: A systematic comparison of United States small-area disadvantage indices. Health Place 2023; 80:102997. [PMID: 36867991 PMCID: PMC10038931 DOI: 10.1016/j.healthplace.2023.102997] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/02/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Abstract
Extensive evidence demonstrates the effects of area-based disadvantage on a variety of life outcomes, such as increased mortality and low economic mobility. Despite these well-established patterns, disadvantage, often measured using composite indices, is inconsistently operationalized across studies. To address this issue, we systematically compared 5 U.S. disadvantage indices at the county-level on their relationships to 24 diverse life outcomes related to mortality, physical health, mental health, subjective well-being, and social capital from heterogeneous data sources. We further examined which domains of disadvantage are most important when creating these indices. Of the five indices examined, the Area Deprivation Index (ADI) and Child Opportunity Index 2.0 (COI) were most related to a diverse set of life outcomes, particularly physical health. Within each index, variables from the domains of education and employment were most important in relationships with life outcomes. Disadvantage indices are being used in real-world policy and resource allocation decisions; an index's generalizability across diverse life outcomes, and the domains of disadvantage which constitute the index, should be considered when guiding such decisions.
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Affiliation(s)
- Sophia Lou
- Technology and Translational Research Unit, National Institute on Drug Abuse, 251 Bayview Blvd., Baltimore, MD, 21224, USA
| | - Salvatore Giorgi
- Technology and Translational Research Unit, National Institute on Drug Abuse, 251 Bayview Blvd., Baltimore, MD, 21224, USA; Department of Computer and Information Science, University of Pennsylvania, 3330 Walnut St, Philadelphia, PA, 19104, USA
| | - Tingting Liu
- Technology and Translational Research Unit, National Institute on Drug Abuse, 251 Bayview Blvd., Baltimore, MD, 21224, USA; Positive Psychology Center, Department of Psychology, University of Pennsylvania, 425 S. University Ave, Philadelphia, PA, 19104, USA
| | - Johannes C Eichstaedt
- Department of Psychology and Institute for Human-Centered AI, Stanford University, 210 Panama St., Stanford, CA, 94305, USA
| | - Brenda Curtis
- Technology and Translational Research Unit, National Institute on Drug Abuse, 251 Bayview Blvd., Baltimore, MD, 21224, USA.
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Rosenberg SI, Ouweleen AJ, Hall TB, Patel NM. Are Neighborhood Conditions Associated With Surgical Delays and Meniscus Tears in Children and Adolescents Undergoing ACL Reconstruction? Clin Orthop Relat Res 2023; 481:281-288. [PMID: 36103207 PMCID: PMC9831176 DOI: 10.1097/corr.0000000000002368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Markers of a patient's social determinants of health, including healthcare insurance and median household income based on ZIP Code, have been associated with the interval between injury and ACL reconstruction (ACLR) as well as the presence of concomitant meniscus tears in children and adolescents. However, the aforementioned surrogate indicators of a patient's social determinants of health may not reflect all socioeconomic and healthcare resources affecting the care of ACL injuries in children and adolescents. The use of multivariate indices such as the Child Opportunity Index (COI) may help to better identify patients at risk for increased risk for delay between ACL injury and surgery, as well as the incidence of meniscus tears at the time of surgery. The COI is a summative measure of 29 indicators that reflect neighborhood opportunities across three domains: education, health and environment, and social and economic factors. COI scores range from 0 to 100 (100 being the highest possible score), as well as five categorical scores (very low, low, moderate, high, and very high) based on quintile rankings. QUESTIONS/PURPOSES To investigate the relationship between neighborhood conditions and the treatment of ACL injuries in children and adolescents via the COI, we asked: (1) Is a lower COI score associated with a longer delay between ACL injury and surgery? (2) Does a higher proportion of patients with lower COI scores have meniscus tears at the time of ACLR? METHODS In this retrospective, comparative study, we considered data from 565 patients, 18 years or younger, who underwent primary ACLR at an urban, tertiary children's hospital between 2011 and 2021. Of these patients, 5% (31 of 565) did not have a clearly documented date of injury, 2% (11 of 565) underwent revision reconstructions, and 1% (5 of 565) underwent intentionally delayed or staged procedures. Because we specifically sought to compare patients who had low or very low COI scores (lowest two quintiles) with those who had high or very high scores (highest two quintiles), we excluded 18% (103 of 565) of patients with moderate scores. Ultimately, 73% (415 of 565) of patients with COI scores in either the top or bottom two quintiles were included. Patient addresses at the time of surgery were used to determine the COI score. There were no differences between the groups in terms of gender. However, patients with high or very high COI scores had a lower median (IQR) age (15 years [2.6] versus 17 years [1.8]; p < 0.001) and BMI (23 kg/m 2 [6.1] versus 25 kg/m 2 [8.8]; p < 0.001), were more commonly privately insured (62% [117 of 188] versus 22% [51 of 227]; p < 0.001), and had a higher proportion of patients identifying as White (67% [126 of 188] versus 6.2% [14 of 227]; p < 0.001) compared with patients with low or very low COI scores. Medical records were reviewed for demographic, preoperative, and intraoperative data. Univariate analyses focused on the relationship of the COI and interval between injury and surgery, frequency of concomitant meniscus tears, and frequency of irreparable meniscus tears treated with partial meniscectomy. Multivariable regression analyses were used to determine factors that were independently associated with delayed surgery (longer than 60 and 90 days after injury), presence of concomitant meniscal injuries, and performance of meniscectomy. Multivariable models included insurance and race or ethnicity to determine whether COI was independently associative after accounting for these variables. RESULTS Patients with a high or very high COI score had surgery earlier than those with a low or very low COI score (median [IQR] 53 days [53] versus 97 days [104]; p < 0.001). After adjusting for insurance and race/ethnicity, we found that patients with a low or very low COI score were more likely than patients with a high or very high COI score to have surgery more than 60 days after injury (OR 2.1 [95% CI 1.1 to 4.0]; p = 0.02) or more than 90 days after injury (OR 1.8 [95% CI 1.1 to 3.4]; p = 0.04). Furthermore, patients with low or very low COI scores were more likely to have concomitant meniscus tears (OR 1.6 [95% CI 1.1 to 2.5]; p = 0.04) compared with patients with high or very high COI scores. After controlling for insurance, race/ethnicity, time to surgery, and other variables, there was no association between COI and meniscectomy (OR 1.6 [95% CI 0.9 to 2.8]; p = 0.12) or presence of a chondral injury (OR 1.7 [95% CI 0.7 to 3.9]; p = 0.20). CONCLUSION As the COI score is independently associated with a delay between ACL injury and surgery as well as the incidence of meniscus tears at the time of surgery, this score can be useful in identifying patients and communities at risk for disparate care after ACL injury. The COI score or similar metrics can be incorporated into medical records to identify at-risk patients and dedicate appropriate resources for efficient care. Additionally, neighborhoods with a low COI score may benefit from improvements in the availability of additional and/or improved resources. Future studies should focus on the relationship between the COI score and long-term patient-reported functional outcomes after ACL injury, identification of the specific timepoints in care that lead to delayed surgery for those with lower COI scores, and the impact of community-based interventions in improving health equity in children with ACL injury. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
| | | | - Tyler B. Hall
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neeraj M. Patel
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Orthopaedic Surgery and Sports Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Cushing AM, Liberman DB, Pham PK, Michelson KA, Festekjian A, Chang TP, Chaudhari PP. Mental Health Revisits at US Pediatric Emergency Departments. JAMA Pediatr 2023; 177:168-176. [PMID: 36574251 PMCID: PMC9856860 DOI: 10.1001/jamapediatrics.2022.4885] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/11/2022] [Indexed: 12/29/2022]
Abstract
Importance Pediatric emergency department (ED) visits for mental health crises are increasing. Patients who frequently use the ED are of particular concern, as pediatric mental health ED visits are commonly repeat visits. Better understanding of trends and factors associated with mental health ED revisits is needed for optimal resource allocation and targeting of prevention efforts. Objective To describe trends in pediatric mental health ED visits and revisits and to determine factors associated with revisits. Design, Setting, and Participants In this cohort study, data were obtained from 38 US children's hospital EDs in the Pediatric Health Information System between October 1, 2015, and February 29, 2020. The cohort included patients aged 3 to 17 years with a mental health ED visit. Exposures Characteristics of patients, encounters, hospitals, and communities. Main Outcomes and Measures The primary outcome was a mental health ED revisit within 6 months of the index visit. Trends were assessed using cosinor analysis and factors associated with time to revisit using mixed-effects Cox proportional hazards regression. Results There were 308 264 mental health ED visits from 217 865 unique patients, and 13.2% of patients had a mental health revisit within 6 months. Mental health visits increased by 8.0% annually (95% CI, 4.5%-11.4%), whereas all other ED visits increased by 1.5% annually (95% CI, 0.1%-2.9%). Factors associated with mental health ED revisits included psychiatric comorbidities, chemical restraint use, public insurance, higher area measures of child opportunity, and presence of an inpatient psychiatric unit at the presenting hospital. Patients with psychotic disorders (hazard ratio [HR], 1.42; 95% CI, 1.29-1.57), disruptive or impulse control disorders (HR, 1.36; 95% CI, 1.30-1.42), and neurodevelopmental disorders (HR, 1.22; 95% CI, 1.14-1.30) were more likely to revisit. Patients with substance use disorders (HR, 0.60; 95% CI, 0.55-0.66) were less likely to revisit. Conclusions and Relevance Markers of disease severity and health care access were associated with mental health revisits. Directing hospital and community interventions toward identified high-risk patients is needed to help mitigate recurrent mental health ED use and improve mental health care delivery.
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Affiliation(s)
- Anna M. Cushing
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
| | - Danica B. Liberman
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Phung K. Pham
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
| | - Kenneth A. Michelson
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Ara Festekjian
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Todd P. Chang
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Pradip P. Chaudhari
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles
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50
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Heneghan JA, Raval MV, Ramgopal S. Neighborhood opportunity and pediatric trauma. J Pediatr Surg 2023; 58:182-184. [PMID: 35934525 DOI: 10.1016/j.jpedsurg.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Julia A Heneghan
- Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital; University of Minnesota, 2450 Riverside Ave S AO-301, Minneapolis, MN 55454, USA.
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sriram Ramgopal
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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