Abstract
Objective
Neighborhood conditions influence child health outcomes, but data examining association
between local factors and hospital utilization are lacking. We determined if hospitals’
mix of patients by neighborhood opportunity correlates with rehospitalization for
common diagnoses at U.S. children's hospitals.
Methods
We analyzed all discharges in 2018 for children ≤18 years at 47 children's hospitals
for 14 common diagnoses. The exposure was hospital-level mean neighborhood opportunity
– measured by Child Opportunity Index (COI) – for each diagnosis. The outcome was
same-cause rehospitalization within 365 days. We measured association via Pearson
correlation coefficient. For diagnoses with significant associations, we also examined
shorter rehospitalization time windows and compared unadjusted and COI-adjusted rehospitalization
rates.
Results
There were 256,871 discharges included. Hospital-level COI ranged from 17th to 70th percentile nationally. Hospitals serving lower COI neighborhoods had more frequent
rehospitalization for asthma (ρ -0.34 [95% CI -0.57, -0.06]) and diabetes (ρ -0.33
[-0.56, -0.04]), but fewer primary mental health rehospitalizations (ρ 0.47 [0.21,
0.67]). There was no association for 11 other diagnoses. Secondary timepoint analysis
revealed increasing correlation over time, with differences by diagnosis. Adjustment
for hospital-level COI resulted in 26%, 32%, and 45% of hospitals changing >1 decile
in rehospitalization rank order for diabetes, asthma, and mental health diagnoses,
respectively.
Conclusions
Children's hospitals vary widely in their mix of neighborhoods served. Asthma, diabetes,
and mental health rehospitalization rates correlate with COI, suggesting that neighborhood
factors may influence outcome disparities for these conditions. Hospital outcomes
may be affected by neighborhood opportunity, which has implications for benchmarking.
Keywords
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Article Info
Publication History
Accepted:
May 10,
2022
Received in revised form:
April 27,
2022
Received:
December 13,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc. on behalf of Academic Pediatric Association
