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

Creator(s)

Molly Krager, Children's Mercy HospitalFollow
Henry T. Puls, Children's Mercy HospitalFollow
Jessica L. Bettenhausen, Children's Mercy HospitalFollow
Matt Hall
Cary Thurm
Laura Plencner, Children's Mercy HospitalFollow
Jessica L. Markham, Children's Mercy HospitalFollow
Clemens Noelke
Andrew F. Beck

Document Type

Article

Publication Date

8-2021

Identifier

DOI: 10.1542/peds.2020-032755

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.

Journal Title

Pediatrics

Volume

148

Issue

2

Recommended Citation

Krager MK, Puls HT, Bettenhausen JL, et al. The Child Opportunity Index 2.0 and Hospitalizations for Ambulatory Care Sensitive Conditions. Pediatrics. 2021;148(2):e2020032755. doi:10.1542/peds.2020-032755