91 - Neighborhood Child Opportunity and Emergency Department Utilization

Poster Number: 91
Publication Number: 91.211

Sunitha V. Kaiser, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Matthew Hall, Children's Hospital Association, Lenexa, Kansas, KS, United States; Jessica Bettenhausen, Children's Mercy Kansas City, Kansas City, MO, United States; Marion R. Sills, University of Colorado School of Medicine, Denver, CO, United States; Jennifer A. Hoffmann, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Clemens Noelke, Brandeis University, Waltham, MA, United States; Rustin Morse, Nationwide Children's Hospital, Columbus, OH, United States; Michelle Lopez, Baylor College of Medicine, Houston, TX, United States; Kavita Parikh, Children's National Health System, Washington DC, DC, United States

Background: The Child Opportunity Index (COI) is a multi-dimensional measure of structural neighborhood context that may influence a child’s healthy development. It includes 29 indicators that span 3 domains: education, health and environment, and social and economic factors. Prior analyses have found that lower COI (lower quality of neighborhood resources and conditions) is associated with higher healthcare utilization and costs, but these studies have largely been limited to single metropolitan areas.

Objective: To determine if COI is associated with children’s emergency department (ED) utilization, using a national sample.

Design/Methods: For this retrospective cohort study, we used the Pediatric Health Information Systems Database (an administrative database from 49 US children’s hospitals). We analyzed children ages 0-17 years with ED visits between January 1, 2018-December 31, 2019. We modeled associations between COI and healthcare utilization outcomes using generalized regression models that adjusted for patient characteristics (e.g., age, sex, clinical severity). Outcomes included: 1) low-resource-intensity ED visits (LRI; visits with no labs, imaging, procedures, or hospital admission); 2) >2 or >3 ED visits during the study period, and 3) hospital admission from the ED.

Results: A total of 6,810,864 ED visits by 3,999,880 children were included in our analyses (Table 1). The majority of children with ED visits were from the lowest COI quintiles (29.1% very low COI, 19.2% low COI). Of all ED encounters, 31% were LRI, and these visits were more likely among children from very low compared to very high COI (for 1 LRI ED visit: Odds Ratio [OR] 1.35 [1.17-1.56]; for >2 LRI ED visits OR 1.97 [1.66-2.33]; for >3 LRI ED visits OR 2.4 [1.71-3.39]) (Table 2). ED utilization was more likely among children from very low compared to very high COI (for >2 ED visits OR 1.73 [1.51-1.99]; for >3 ED visits OR 2.22 [1.69-2.91]. Risk of hospital admission from the ED was lower for children from very low compared to very high COI (OR 0.77 [0.65-0.99]).Conclusion(s): We found that children from neighborhoods with very low and low child opportunity had higher rates of ED utilization overall and of LRI visits-- visits that may be more efficiently handled in primary care settings. Research to identify and address neighborhood opportunity-related drivers can help us design policy, community, and healthcare interventions to optimize child health and decrease unnecessary ED utilization and costs.
Table 1
Table 2