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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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Tyris J, Putnick DL, Bell EM, McAdam J, Lin TC, Parikh K, Yeung E. Early Child Opportunity Index Mobility, Recurrent Wheezing, and Asthma: A Population-based Prospective Cohort Study. J Pediatr 2024:114121. [PMID: 38815746 DOI: 10.1016/j.jpeds.2024.114121] [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: 03/12/2024] [Revised: 05/02/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
We prospectively examined associations between mobility in neighborhood opportunity and early childhood recurrent wheezing/asthma. Downward mobility was associated with developing asthma, but not recurrent wheezing, though associations were attenuated after adjusting for family-level socioeconomic status. Elucidating how neighborhoods impact asthma may inform asthma equity initiatives in early childhood.
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Affiliation(s)
- Jordan Tyris
- Children's National Hospital, Washington, DC;; George Washington University School of Medicine and Health Sciences, Washington, DC;; Epidemiology Branch, 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, 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 McAdam
- Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences
| | | | - Kavita Parikh
- Children's National Hospital, Washington, DC;; George Washington University School of Medicine and Health Sciences, Washington, DC
| | - 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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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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Hoffmann JA, Carter CP, Olsen CS, Ashby D, Bouvay KL, Duffy SJ, Chamberlain JM, Chaudhary SS, Glomb NW, Grupp-Phelan J, Haasz M, O'Donnell EP, Saidinejad M, Shihabuddin BS, Tzimenatos L, Uspal NG, Zorc JJ, Cook LJ, Alpern ER. Pediatric mental health emergency department visits from 2017 to 2022: A multicenter study. Acad Emerg Med 2024. [PMID: 38563444 DOI: 10.1111/acem.14910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/20/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The COVID-19 pandemic adversely affected children's mental health (MH) and changed patterns of MH emergency department (ED) utilization. Our objective was to assess how pediatric MH ED visits during the COVID-19 pandemic differed from expected prepandemic trends. METHODS We retrospectively studied MH ED visits by children 5 to <18 years old at nine U.S. hospitals participating in the Pediatric Emergency Care Applied Research Network Registry from 2017 to 2022. We described visit length by time period: prepandemic (January 2017-February 2020), early pandemic (March 2020-December 2020), midpandemic (2021), and late pandemic (2022). We estimated expected visit rates from prepandemic data using multivariable Poisson regression models. We calculated rate ratios (RRs) of observed to expected visits per 30 days during each pandemic time period, overall and by sociodemographic and clinical characteristics. RESULTS We identified 175,979 pediatric MH ED visits. Visit length exceeded 12 h for 7.3% prepandemic, 8.4% early pandemic, 15.0% midpandemic, and 19.2% late pandemic visits. During the early pandemic, observed visits per 30 days decreased relative to expected rates (RR 0.80, 95% confidence interval [CI] 0.78-0.84), were similar to expected rates during the midpandemic (RR 1.01, 95% CI 0.96-1.07), and then decreased below expected rates during the late pandemic (RR 0.92, 95% CI 0.86-0.98). During the late pandemic, visit rates were higher than expected for females (RR 1.10, 95% CI 1.02-1.20) and for bipolar disorders (RR 1.83, 95% CI 1.38-2.75), schizophrenia spectrum disorders (RR 1.55, 95% CI 1.10-2.59), and substance-related and addictive disorders (RR 1.50, 95% CI 1.18-2.05). CONCLUSIONS During the late pandemic, pediatric MH ED visits decreased below expected rates; however, visits by females and for specific conditions remained elevated, indicating a need for increased attention to these groups. Prolonged ED visit lengths may reflect inadequate availability of MH services.
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Affiliation(s)
- Jennifer A Hoffmann
- 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
| | - Camille P Carter
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Cody S Olsen
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - David Ashby
- Division of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Kamali L Bouvay
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Susan J Duffy
- Department of Emergency Medicine, Brown University, Hasbro Children's Hospital, Providence, Rhode Island, USA
- Department of Pediatrics, Brown University, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - James M Chamberlain
- Division of Emergency Medicine, Children's National Medical Center, Washington, DC, USA
| | - Sofia S Chaudhary
- Division of Emergency Medicine, Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Nicolaus W Glomb
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jacqueline Grupp-Phelan
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Maya Haasz
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Erin P O'Donnell
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mohsen Saidinejad
- Department of Emergency Medicine, The Lundquist Institute for Biomedical Innovation at Harbor UCLA, Harbor UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Bashar S Shihabuddin
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Leah Tzimenatos
- Department of Emergency Medicine, University of California, Davis, Sacramento, California, USA
| | - Neil G Uspal
- Division of Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Joseph J Zorc
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lawrence J Cook
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, 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
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Gueye-Ndiaye S, Tully M, Amin R, Baldassari CM, Chervin RD, Cole M, Ibrahim S, Kirkham EM, Mitchell RB, Naqvi K, Ross K, Rueschman M, Tapia IE, Williamson AA, Wei Z, Rosen CL, Wang R, Redline S. Neighborhood Disadvantage, Quality of Life, and Symptom Burden in Children with Mild Sleep-disordered Breathing. Ann Am Thorac Soc 2024; 21:604-611. [PMID: 38241286 PMCID: PMC10995551 DOI: 10.1513/annalsats.202307-653oc] [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: 07/28/2023] [Accepted: 01/18/2024] [Indexed: 01/21/2024] Open
Abstract
Rationale: Neighborhood disadvantage (ND) has been associated with sleep-disordered breathing (SDB) in children. However, the association between ND and SDB symptom burden and quality of life (QOL) has not yet been studied.Objectives: To evaluate associations between ND with SDB symptom burden and QOL.Methods: Cross-sectional analyses were performed on 453 children, ages 3-12.9 years, with mild SDB (habitual snoring and apnea-hypopnea index < 3/h) enrolled in the PATS (Pediatric Adenotonsillectomy Trial for Snoring) multicenter study. The primary exposure, neighborhood disadvantage, was characterized by the Child Opportunity Index (COI) (range, 0-100), in which lower values (specifically COI ⩽ 40) signify less advantageous neighborhoods. The primary outcomes were QOL assessed by the obstructive sleep apnea (OSA)-18 questionnaire (range, 18-126) and SDB symptom burden assessed by the Pediatric Sleep Questionnaire-Sleep-related Breathing Disorder (PSQ-SRBD) scale (range, 0-1). The primary model was adjusted for age, sex, race, ethnicity, maternal education, recruitment site, and season. In addition, we explored the role of body mass index (BMI) percentile, environmental tobacco smoke (ETS), and asthma in these associations.Results: The sample included 453 children (16% Hispanic, 26% Black or African American, 52% White, and 6% other). COI mean (standard deviation [SD]) was 50.3 (29.4), and 37% (n = 169) of participants lived in disadvantaged neighborhoods. Poor SDB-related QOL (OSA-18 ⩾ 60) and high symptom burden (PSQ-SRBD ⩾ 0.33) were found in 30% (n = 134) and 75% (n = 341) of participants, respectively. In adjusted models, a COI increase by 1 SD (i.e., more advantageous neighborhood) was associated with an improvement in OSA-18 score by 2.5 points (95% confidence interval [CI], -4.34 to -0.62) and in PSQ-SRBD score by 0.03 points (95% CI, -0.05 to -0.01). These associations remained significant after adjusting for BMI percentile, ETS, or asthma; however, associations between COI and SDB-related QOL attenuated by 23% and 10% after adjusting for ETS or asthma, respectively.Conclusions: Neighborhood disadvantage was associated with poorer SDB-related QOL and greater SDB symptoms. Associations were partially attenuated after considering the effects of ETS or asthma. The findings support efforts to reduce ETS and neighborhood-level asthma-related risk factors and identify other neighborhood-level factors that contribute to SDB symptom burden as strategies to address sleep-health disparities.Clinical trial registered with www.clinicaltrials.gov (NCT02562040).
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Affiliation(s)
- Seyni Gueye-Ndiaye
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meg Tully
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raouf Amin
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Cristina M. Baldassari
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, Virginia
- Department of Pediatric Sleep Medicine, Children’s Hospital of The King’s Daughters, Norfolk, Virginia
| | | | - Melissa Cole
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sally Ibrahim
- Rainbow Babies and Children’s Hospital and University Hospitals, Cleveland, Ohio
| | | | - Ron B. Mitchell
- Children’s Medical Center of Dallas and UT Southwestern Medical Center, Dallas, Texas
| | - Kamal Naqvi
- Children’s Medical Center of Dallas and UT Southwestern Medical Center, Dallas, Texas
| | - Kristie Ross
- Rainbow Babies and Children’s Hospital and University Hospitals, Cleveland, Ohio
| | - Michael Rueschman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ignacio E. Tapia
- Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ariel A. Williamson
- The Ballmer Institute for Children’s Behavioral Health, University of Oregon, Eugene, Oregon
| | - Zhuoran Wei
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carol L. Rosen
- Case Western Reserve University School of Medicine, Cleveland, Ohio; and
| | - Rui Wang
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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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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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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Jaboyedoff M, Starvaggi C, Suris JC, Kuehni CE, Gehri M, Keitel K. Drivers for low-acuity pediatric emergency department visits in two tertiary hospitals in Switzerland: a cross-sectional, questionnaire-based study. BMC Health Serv Res 2024; 24:103. [PMID: 38238764 PMCID: PMC10797974 DOI: 10.1186/s12913-023-10348-3] [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: 12/30/2022] [Accepted: 11/18/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE Low-acuity pediatric emergency department (PED) visits are frequent in high-income countries and have a negative impact on patient care at the individual and health system levels. Knowing what drives low-acuity PED visits is crucial to inform adaptations in health care delivery. We aimed to identify factors associated with low-acuity PED visits in Switzerland, including socioeconomic status, demographic features, and medical resources of families. METHODS We conducted a prospective, questionnaire-based study in the PEDs of two Swiss tertiary care hospitals, Bern and Lausanne. We invited all consecutive children and their caregiver attending the PED during data collection times representative of the overall PED consultation structure (e.g. day/night, weekdays/weekends) to complete a questionnaire on demographic features, socioeconomic status, and medical resources. We collected medical and administrative data about the visit and defined low-acuity visits as those meeting all of the following criteria: (1) triage category 4 or 5 on the Australasian Triage Scale, (2) no imaging or laboratory test performed, and (3) discharge home. We used a binary multiple logistic regression model to identify factors associated with low-acuity visits. RESULTS We analysed 778 PED visits (September 2019 to July 2020). Most children visiting our PEDs had a designated primary care provider (92%), with only 6% not having seen them during the last year. Fifty-five per cent of caregivers had asked for medical advice before coming to the PED. The proportion of low-acuity visits was 58%. Low-acuity visits were associated with caregiver's difficulties paying bills (aOR 2.6, 95% CI 1.6 - 4.4), having already visited a PED in the last 6 months (aOR 1.7, 95% CI 1.1 - 2.5) but not with parental education status, nor parental country of birth, parental employment status or absence of family network. CONCLUSION Economic precariousness is an important driver for low-acuity PED visits in Switzerland, a high-income country with compulsory health coverage where most children have a designated primary care provider and a regular pediatric follow-up. Primary care providers and PEDs should screen families for economic precariousness and offer anticipatory guidance and connect those in financial need to social support.
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Affiliation(s)
- Manon Jaboyedoff
- Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Carl Starvaggi
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joan-Carles Suris
- Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Mario Gehri
- Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kristina Keitel
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Cafferty R, Grupp-Phelan J, Anthony B. Children and Adolescents With Suicidal Ideation and the Emergency Department. JAMA 2024; 331:193-194. [PMID: 38153704 DOI: 10.1001/jama.2023.26291] [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: 12/29/2023]
Abstract
This Viewpoint discusses the need for formal training in suicide prevention for frontline emergency clinicians and staff, including standardized screening practices, assessment and targeted interventions, and increased connection to outpatient mental health services after discharge from the emergency department.
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Affiliation(s)
- Rachel Cafferty
- Children's Hospital Colorado, Aurora
- University of Colorado School of Medicine, Aurora
| | | | - Bruno Anthony
- University of Colorado School of Medicine, Aurora
- Partners for Children's Mental Health, Aurora, Colorado
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Berry JG, Ferrari L, Ward VL, Hall M, Desmarais A, Raval MV, Tian Y, Mathieu D, Incorvia J, Meara JG. Child Opportunity Index Disparities in Pediatric Surgical Encounters During the Coronavirus 2019 Pandemic. Acad Pediatr 2024; 24:43-50. [PMID: 37625667 DOI: 10.1016/j.acap.2023.08.012] [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: 03/31/2023] [Revised: 08/04/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Surgical encounters decreased during the coronavirus disease (COVID-19) pandemic and may have been deferred more in children with impeded health care access related to social/community risk factors. We compared surgery trends before and during the pandemic by Child Opportunity Index (COI). METHODS Retrospective analysis of 321,998 elective surgical encounters of children ages 0-to-18 years in 44 US children's hospitals from January 1, 2017 to December 31, 2021. We used auto-regression to compare observed versus predicted encounters by month in 2020-21, modeled from 2017 to 2019 trends. Encounters were compared by COI score (very low, low, moderate, high, very high) based on education, health/environment, and social/economic attributes of the zip code from the children's home residence. RESULTS Most surgeries were on the musculoskeletal (28.1%), ear/nose/pharynx (17.1%), cardiovascular (15.1%), and digestive (9.1%) systems; 20.6% of encounters were for children with very low COI, 20.8% low COI, 19.8% moderate COI, 18.6% high COI, and 20.1% very high COI. Reductions in observed volume of 2020-21 surgeries compared with predicted varied significantly by COI, ranging from -11.3% (95% confidence interval [CI] -14.1%, -8.7%) for very low COI to -2.6% (95%CI -3.9%, 0.7%) for high COI. Variation by COI emerged in June 2020, as the volume of elective surgery encounters neared baseline. For 12 of the next 18 months, the reduction in volume of elective surgery encounters was the greatest in children with very low COI. CONCLUSIONS Children from very low COI zip codes experienced the greatest reduction in elective surgery encounters during early COVID-19 without a subsequent increase in encounters over time to counterbalance the reduction.
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Affiliation(s)
- Jay G Berry
- Complex Care (JG Berry and A Desmarais), Division of General Pediatrics, Boston Children's Hospital, Mass; Department of Plastic and Oral Surgery (JG Berry, J Incorvia, and JG Meara), Boston Children's Hospital, Mass; Department of Pediatrics (JG Berry), Harvard Medical School, Boston, Mass.
| | - Lynne Ferrari
- Perioperative Anesthesia (L Ferrari), Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, Mass
| | - Valerie L Ward
- Department of Radiology (VL Ward), Boston Children's Hospital and Harvard Medical School, Mass; Office of Health Equity and Inclusion (VL Ward), Boston Children's Hospital, Mass; Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion (VL Ward), Boston Children's Hospital, Mass
| | - Matt Hall
- Children's Hospital Association (M Hall), Lenexa, Kans
| | - Anna Desmarais
- Complex Care (JG Berry and A Desmarais), Division of General Pediatrics, Boston Children's Hospital, Mass
| | - Mehul V Raval
- Surgical Outcomes Quality Improvement Center (MV Raval and Y Tian), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill; Division of Pediatric Surgery (MV Raval), Department of Surgery, Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital, Chicago, Ill
| | - Yao Tian
- Surgical Outcomes Quality Improvement Center (MV Raval and Y Tian), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Derek Mathieu
- Department of Finance (D Mathieu), Boston Children's Hospital, Mass; Department of Surgery (D Mathieu), Harvard Medical School, Boston, Mass
| | - Joseph Incorvia
- Department of Plastic and Oral Surgery (JG Berry, J Incorvia, and JG Meara), Boston Children's Hospital, Mass
| | - John G Meara
- Department of Plastic and Oral Surgery (JG Berry, J Incorvia, and JG Meara), Boston Children's Hospital, Mass
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Garg A, Sochet AA, Hernandez R, Stockwell DC. Association of the Child Opportunity Index and Inpatient Illness Severity in the United States, 2018-2019. Acad Pediatr 2023:S1876-2859(23)00473-4. [PMID: 38159600 DOI: 10.1016/j.acap.2023.12.008] [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: 09/08/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
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.
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Affiliation(s)
- Anjali Garg
- Department of Anesthesia and Critical Care Medicine (A Garg, AA Sochet, and DC Stockwell), Johns Hopkins School of Medicine, Baltimore, Md.
| | - Anthony A Sochet
- 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
| | - Raquel Hernandez
- 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
| | - David C Stockwell
- Department of Anesthesia and Critical Care Medicine (A Garg, AA Sochet, and DC Stockwell), Johns Hopkins School of Medicine, Baltimore, Md
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Hoffmann JA, Carter CP, Olsen CS, Chaudhari PP, Chaudhary S, Duffy S, Glomb N, Goyal MK, Grupp-Phelan J, Haasz M, Ketabchi B, Kravitz-Wirtz N, Lerner EB, Shihabuddin B, Wendt W, Cook LJ, Alpern ER. Pediatric Firearm Injury Emergency Department Visits From 2017 to 2022: A Multicenter Study. Pediatrics 2023; 152:e2023063129. [PMID: 37927086 PMCID: PMC10842699 DOI: 10.1542/peds.2023-063129] [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: 08/30/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Pediatric firearm injuries increased during the coronavirus disease 2019 pandemic, but recent trends in firearm injury emergency department (ED) visits are not well described. We aimed to assess how pediatric firearm injury ED visits during the pandemic differed from expected prepandemic trends. METHODS We retrospectively studied firearm injury ED visits by children <18 years old at 9 US hospitals participating in the Pediatric Emergency Care Applied Research Network Registry before (January 2017 to February 2020) and during (March 2020 to November 2022) the pandemic. Multivariable Poisson regression models estimated expected visit rates from prepandemic data. We calculated rate ratios (RRs) of observed to expected visits per 30 days, overall, and by sociodemographic characteristics. RESULTS We identified 1904 firearm injury ED visits (52.3% 15-17 years old, 80.0% male, 63.5% non-Hispanic Black), with 694 prepandemic visits and 1210 visits during the pandemic. Death in the ED/hospital increased from 3.1% prepandemic to 6.1% during the pandemic (P = .007). Firearm injury visits per 30 days increased from 18.0 prepandemic to 36.1 during the pandemic (RR 2.09, 95% CI 1.63-2.91). Increases beyond expected rates were seen for 10- to 14-year-olds (RR 2.61, 95% CI 1.69-5.71), females (RR 2.46, 95% CI 1.55-6.00), males (RR 2.00, 95% CI 1.53-2.86), Hispanic children (RR 2.30, 95% CI 1.30-9.91), and Black non-Hispanic children (RR 1.88, 95% CI 1.34-3.10). CONCLUSIONS Firearm injury ED visits for children increased beyond expected prepandemic trends, with greater increases among certain population subgroups. These findings may inform firearm injury prevention efforts.
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Affiliation(s)
- Jennifer A Hoffmann
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Camille P Carter
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Cody S Olsen
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - 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
| | - Sofia Chaudhary
- Division of Emergency Medicine, Department of Pediatrics and Department of Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Susan Duffy
- Departments of Emergency Medicine and Pediatrics, Brown University, Hasbro Children's Hospital, Providence, Rhode Island
| | - Nicolaus Glomb
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, George Washington University, Washington, District of Columbia
| | - Jacqueline Grupp-Phelan
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California
| | - Maya Haasz
- Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Bijan Ketabchi
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Nicole Kravitz-Wirtz
- Department of Emergency Medicine, University of California, Davis, Sacramento, California
| | - E Brooke Lerner
- Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Bashar Shihabuddin
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Wendi Wendt
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lawrence J Cook
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - 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, IL
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DiFiore G, Wood S, Jenssen BP, Fiks AG, Mayne SL. Cumulative Health Vulnerabilities Among Adolescents by Age and Neighborhood Opportunity. Pediatrics 2023; 152:e2023062657. [PMID: 37974515 PMCID: PMC10774653 DOI: 10.1542/peds.2023-062657] [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: 09/07/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Early detection of health vulnerabilities in adolescents is integral to promoting healthy behaviors into adulthood. Our objective was to quantify the prevalence of health vulnerabilities among adolescents and examine differences by age and neighborhood opportunity. METHODS In a cross-sectional analysis of electronic health record data for adolescents aged 13 to 18 years with preventive visits in a large pediatric primary care network between September 2021 and September 2022, we examined 5 health vulnerabilities: Tobacco use, substance use, firearm access, condomless intercourse, and depressive symptoms. Health vulnerabilities were assessed via self-reported adolescent health questionnaire and the validated Patient Health Questionnaire-Modified. Prevalence of health vulnerabilities were calculated alone and in combination, and compared by age and by quintile of neighborhood Child Opportunity Index (COI) score. Multivariable logistic regression estimated associations of neighborhood COI with reporting ≥2 health vulnerabilities. RESULTS Among 40 197 adolescents (57.7% aged 13-15 years, 66.3% living in "high"/"very high" COI neighborhoods), 29.7% reported at least 1 health vulnerability and 7.9% reported ≥2 vulnerabilities. Cumulative health vulnerabilities were more prevalent among older adolescents and adolescents from lower opportunity neighborhoods. In adjusted models, lower COI was associated with 65% higher odds of having ≥2 vulnerabilities (odds ratio 1.65, 95% confidence interval 1.43-1.91) compared with adolescents from the highest COI quintile. CONCLUSIONS Understanding the relationship between health vulnerabilities and neighborhood opportunities among adolescents may allow pediatric primary care providers and health systems to offer more tailored community support services and transdiagnostic specialized care navigation to address the health needs of teens with multiple vulnerabilities.
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Affiliation(s)
| | - Sarah Wood
- Clinical Futures and PolicyLab
- The Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian P. Jenssen
- Clinical Futures and PolicyLab
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander G. Fiks
- Clinical Futures and PolicyLab
- The Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie L. Mayne
- Clinical Futures and PolicyLab
- The Department of Pediatrics, Perelman School of Medicine
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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Parikh K, Lopez MA, Hall M, Bettenhausen J, Sills MR, Hoffmann J, Morse R, Shah SS, Noelke C, Kaiser SV. Child Opportunity Index and Rehospitalization for Ambulatory Care Sensitive Conditions at US Children's Hospitals. Hosp Pediatr 2023; 13:1028-1037. [PMID: 37823239 DOI: 10.1542/hpeds.2023-007279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Child Opportunity Index (COI) measures neighborhood contextual factors (education, health and environment, social and economic) that may influence child health. Such factors have been associated with hospitalizations for ambulatory care sensitive conditions (ACSC). Lower COI has been associated with higher health care utilization, yet association with rehospitalization(s) for ACSC remains unknown. Our objective is to determine the association between COI and ACSC rehospitalizations. METHODS Multicenter retrospective cohort study of children ages 0 to 17 years with a hospital admission for ambulatory care sensitive conditions in 2017 or 2018. Exposure was COI. Outcome was rehospitalization within 1 year of index admission (analyzed as any or ≥2 rehospitalization) for ACSC. Logistic regression models adjusted for age, sex, severity, and complex and mental health conditions. RESULTS The study included 184 478 children. Of hospitalizations, 28.3% were by children from very low COI and 16.5% were by children from very high COI neighborhoods. In risk-adjusted models, ACSC rehospitalization was higher for children from very low COI than very high COI neighborhoods; any rehospitalization occurred for 18.7% from very low COI and 13.5% from very high COI neighborhoods (adjusted odds ratio 1.14 [1.05-1.23]), whereas ≥2 rehospitalization occurred for 4.8% from very low COI and 3.2% from very high COI neighborhoods (odds ratio 1.51 [1.29-1.75]). CONCLUSIONS Children from neighborhoods with low COI had higher rehospitalizations for ACSCs. Further research is needed to understand how hospital systems can address social determinants of health in the communities they serve to prevent rehospitalizations.
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Affiliation(s)
- Kavita Parikh
- Division of Hospital Medicine, Children's National Hospital, Washington, DC
| | - Michelle A Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Jessica Bettenhausen
- Division of Pediatric Hospital Medicine, Children's Mercy - Kansas City, Kansas City, Missouri University of Missouri - Kansas City, Kansas City, Missouri
| | - Marion R Sills
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rustin Morse
- The Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Clemens Noelke
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Sunitha V Kaiser
- Department of Pediatrics, University of California, San Francisco, California
- Philip R. Lee Institute for Health Policy Studies, San Francisco, California
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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: 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: 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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