The Child Opportunity Index 2.0 and Hospitalizations for Ambulatory Care Sensitive Conditions

Molly K. Krager · Henry T. Puls · Jessica L. Bettenhausen · Matt Hall · Cary W. Thurm · Laura M. Plencner +3 more

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Health disparities and outcomes Child and Adolescent Health Primary Care and Health Outcomes

Abstract

BACKGROUND AND OBJECTIVES Hospitalizations for ambulatory care sensitive conditions (ACSCs) are thought to be avoidable with high-quality outpatient care. Morbidity related to ACSCs has been associated with socioeconomic contextual factors, which do not necessarily capture the complex pathways through which a child’s environment impacts health outcomes. Our primary objective was to test the association between a multidimensional measure of neighborhood-level child opportunity and pediatric hospitalization rates for ACSCs across 2 metropolitan areas. METHODS This was a retrospective population-based analysis of ACSC hospitalizations within the Kansas City and Cincinnati metropolitan areas from 2013 to 2018. Census tracts were included if located in a county where Children’s Mercy Kansas City or Cincinnati Children’s Hospital Medical Center had >80% market share of hospitalizations for children <18 years. Our predictor was child opportunity as defined by a composite index, the Child Opportunity Index 2.0. Our outcome was hospitalization rates for 8 ACSCs. RESULTS We included 604 943 children within 628 census tracts. There were 26 977 total ACSC hospitalizations (46 hospitalizations per 1000 children; 95% confidence interval [CI]: 45.4–46.5). The hospitalization rate for all ACSCs revealed a stepwise reduction from 79.9 per 1000 children (95% CI: 78.1–81.7) in very low opportunity tracts to 31.2 per 1000 children (95% CI: 30.5–32.0) in very high opportunity tracts (P < .001). This trend was observed across cities and diagnoses. CONCLUSIONS Links between ACSC hospitalizations and child opportunity extend across metropolitan areas. Targeting interventions to lower-opportunity neighborhoods and enacting policies that equitably bolster opportunity may improve child health outcomes, reduce inequities, and decrease health care costs.

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References

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2022Geospatial Analysis of Social Determinants of Health Identifies Neighborhood Hot Spots Associated With Pediatric Intensive Care Use for Acute Respiratory Failure Requiring Mechanical Ventilation*2023Child Opportunity Index and Emergent PICU Readmissions: A Retrospective, Cross-Sectional Study of 43 U.S. Hospitals 2023Measuring disadvantage: A systematic comparison of United States small-area disadvantage indices 2022Hospitalizations at United States Children's Hospitals and Severity of Illness by Neighborhood Child Opportunity Index

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