Association of the Child Opportunity Index and Inpatient Illness Severity in the United States, 2018-2019.

Autor: Garg A; Department of Anesthesia and Critical Care Medicine (A Garg, AA Sochet, and DC Stockwell), Johns Hopkins School of Medicine, Baltimore, Md. Electronic address: agarg15@jhmi.edu., Sochet AA; Department of Anesthesia and Critical Care Medicine (A Garg, AA Sochet, and DC Stockwell), Johns Hopkins School of Medicine, Baltimore, Md; Department of Medicine (AA Sochet), Divisions of Pediatrics, Johns Hopkins All Children's Hospital Institute for Clinical and Translational Research, St. Petersburg, Fla., Hernandez R; Pediatric Critical Care Medicine and Pediatrics (R Hernandez), Johns Hopkins All Children's Hospital Institute for Clinical and Translational Research, St. Petersburg, Fla; Department of Pediatrics (R Hernandez), Johns Hopkins University School of Medicine, Baltimore, Md., Stockwell DC; Department of Anesthesia and Critical Care Medicine (A Garg, AA Sochet, and DC Stockwell), Johns Hopkins School of Medicine, Baltimore, Md.
Jazyk: angličtina
Zdroj: Academic pediatrics [Acad Pediatr] 2024 Sep-Oct; Vol. 24 (7), pp. 1101-1109. Date of Electronic Publication: 2023 Dec 28.
DOI: 10.1016/j.acap.2023.12.008
Abstrakt: Objective: Children residing in impoverished neighborhoods have reduced access to health care resources. Our objective was to identify potential associations between Child Opportunity Index (COI), a composite score of neighborhood characteristics, and inpatient severity of illness and clinical trajectory among United States (US) children.
Methods: This retrospective cohort study assessed data using the Pediatric Health Information System Registry from 2018 to 2019. Primary exposure variable was COI level (range: very low [CO1 1], low [COI 2], moderate [COI 3], high [COI 4], and very high [COI 5]). Markers of inpatient clinical severity included index mortality, Pediatric Intensive Care Unit (PICU) admission, invasive mechanical ventilation (IMV), and hospital length of stay (LOS). Subgroup analysis of COI and clinical outcome variation by United States Census Geographic Regions was conducted. Adjusted regression analysis was utilized to understand associations between COI and inpatient clinical severity outcomes.
Results: Of the 132,130 encounters, 44% resided in very low or low COI neighborhoods. In adjusted models, very low COI was associated with increased mortality (aOR: 1.35, 95% CI: 1.05-1.74, P = .018), PICU admission (aOR: 1.06, 95% CI: 1.02-1.11, P = 0.014), IMV (aOR: 1.12, 95% CI: 1.04-1.21, P = .002), and higher hospital LOS (P = .045). Regional variation by COI depicted the East North Central region having the highest rate of mortality (20.5%), P < .001, and PICU admissions (23%), P = .014.
Conclusions: Our multicenter, retrospective study highlights the interaction between neighborhood-level deprivation and worsened health disparities, indicating a need for prospective study.
Competing Interests: Declaration of Competing Interest A.G. was funded by the Johns Hopkins T32 grant for Training for Clinician Scientists in Pediatric Critical Cardio-pulmonary Disease from the National Heart, Lung, and Blood Institute. This funding source provided support for conduct of the research but did not play a role in the study design, data collection, analysis, or decision to submit the paper for publication. The authors declare no conflicts of interest.
(Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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