Neighborhood Child Opportunity and Emergency Department Utilization

Abstract

The Child Opportunity Index measures the structural neighborhood context that may influence a child’s healthy development. We examined relationships between the Child Opportunity Index and emergency department utilization. BACKGROUND AND OBJECTIVES The Child Opportunity Index (COI) is a multidimensional measure of structural neighborhood context that may influence a child’s healthy development. Our objective was to determine if COI is associated with children’s emergency department (ED) utilization using a national sample. METHODS This was a retrospective cohort study of the Pediatric Health Information Systems, a database from 49 United States children’s hospitals. We analyzed children aged 0 to 17 years with ED visits from January 1, 2018, to December 31, 2019. We modeled associations between COI and outcomes using generalized regression models that adjusted for patient characteristics (eg, age, clinical severity). Outcomes included: (1) low-resource intensity (LRI) ED visits (visits with no laboratories, imaging, procedures, or admission), (2) ≥2 or ≥3 ED visits, and (3) admission. RESULTS We analyzed 6 810 864 ED visits by 3 999 880 children. LRI visits were more likely among children from very low compared with very high COI (1 LRI visit: odds ratio [OR] 1.35 [1.17–1.56]; ≥2 LRI visits: OR 1.97 [1.66–2.33]; ≥3 LRI visits: OR 2.4 [1.71–3.39]). ED utilization was more likely among children from very low compared with very high COI (≥2 ED visits: OR 1.73 [1.51–1.99]; ≥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 with very high COI (OR 0.77 [0.65–0.99]). CONCLUSIONS Children from neighborhoods with low COI had higher ED utilization overall and more LRI visits, as well as visits more cost-effectively managed in primary care settings. Identifying neighborhood opportunity-related drivers can help us design interventions to optimize child health and decrease unnecessary ED utilization and costs.