The Child Opportunity Index and Disparities in Pediatric Asthma Hospitalizations Across One Ohio Metropolitan Area, 2011-2013

To determine whether the Child Opportunity Index (COI), a nationally available measure of relative educational, health/environmental, and social/economic opportunity across census tracts within metropolitan areas, is associated with population- and patient-level asthma morbidity. This population-bas...

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Vydané v:	The Journal of pediatrics Ročník 190; s. 200 - 206.e1
Hlavní autori:	Beck, Andrew F., Huang, Bin, Wheeler, Kathryn, Lawson, Nikki R., Kahn, Robert S., Riley, Carley L.
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States Elsevier Inc 01.11.2017
Predmet:	Adolescent asthma Asthma - economics Asthma - epidemiology Asthma - etiology Asthma - therapy Child Child, Preschool Emergency Service, Hospital - statistics & numerical data Female Follow-Up Studies Health Status Disparities Hospitalization - statistics & numerical data Humans Infant Logistic Models Male Ohio - epidemiology pediatrics Retrospective Studies Risk Factors Social Class social determinants of health Urban Health - economics Urban Health - statistics & numerical data CCHMC social determinants of health HEOI SDH pediatrics asthma OCOI SEOI COI EOI ED
ISSN:	0022-3476, 1097-6833, 1097-6833
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Abstract	To determine whether the Child Opportunity Index (COI), a nationally available measure of relative educational, health/environmental, and social/economic opportunity across census tracts within metropolitan areas, is associated with population- and patient-level asthma morbidity. This population-based retrospective cohort study was conducted between 2011 and 2013 in a southwest Ohio county. Participants included all children aged 1-16 years with hospitalizations or emergency department visits for asthma or wheezing at a major pediatric hospital. Patients were identified using discharge diagnosis codes and geocoded to their home census tract. The primary population-level outcome was census tract asthma hospitalization rate. The primary patient-level outcome was rehospitalization within 12 months of the index hospitalization. Census tract opportunity was characterized using the COI and its educational, health/environmental, and social/economic domains. Across 222 in-county census tracts, there were 2539 geocoded hospitalizations. The median asthma-related hospitalization rate was 5.0 per 1000 children per year (IQR, 1.9-8.9). Median hospitalization rates in very low, low, moderate, high, and very high opportunity tracts were 9.1, 7.6, 4.6, 2.1, and 1.8 per 1000, respectively (P < .0001). The social/economic domain had the most variables significantly associated with the outcome at the population level. The adjusted patient-level analyses showed that the COI was not significantly associated with a patient's risk of rehospitalization within 12 months. The COI was associated with population-level asthma morbidity. The details provided by the COI may inform interventions aimed at increasing opportunity and reducing morbidity across regions.
AbstractList	To determine whether the Child Opportunity Index (COI), a nationally available measure of relative educational, health/environmental, and social/economic opportunity across census tracts within metropolitan areas, is associated with population- and patient-level asthma morbidity.OBJECTIVESTo determine whether the Child Opportunity Index (COI), a nationally available measure of relative educational, health/environmental, and social/economic opportunity across census tracts within metropolitan areas, is associated with population- and patient-level asthma morbidity.This population-based retrospective cohort study was conducted between 2011 and 2013 in a southwest Ohio county. Participants included all children aged 1-16 years with hospitalizations or emergency department visits for asthma or wheezing at a major pediatric hospital. Patients were identified using discharge diagnosis codes and geocoded to their home census tract. The primary population-level outcome was census tract asthma hospitalization rate. The primary patient-level outcome was rehospitalization within 12 months of the index hospitalization. Census tract opportunity was characterized using the COI and its educational, health/environmental, and social/economic domains.STUDY DESIGNThis population-based retrospective cohort study was conducted between 2011 and 2013 in a southwest Ohio county. Participants included all children aged 1-16 years with hospitalizations or emergency department visits for asthma or wheezing at a major pediatric hospital. Patients were identified using discharge diagnosis codes and geocoded to their home census tract. The primary population-level outcome was census tract asthma hospitalization rate. The primary patient-level outcome was rehospitalization within 12 months of the index hospitalization. Census tract opportunity was characterized using the COI and its educational, health/environmental, and social/economic domains.Across 222 in-county census tracts, there were 2539 geocoded hospitalizations. The median asthma-related hospitalization rate was 5.0 per 1000 children per year (IQR, 1.9-8.9). Median hospitalization rates in very low, low, moderate, high, and very high opportunity tracts were 9.1, 7.6, 4.6, 2.1, and 1.8 per 1000, respectively (P < .0001). The social/economic domain had the most variables significantly associated with the outcome at the population level. The adjusted patient-level analyses showed that the COI was not significantly associated with a patient's risk of rehospitalization within 12 months.RESULTSAcross 222 in-county census tracts, there were 2539 geocoded hospitalizations. The median asthma-related hospitalization rate was 5.0 per 1000 children per year (IQR, 1.9-8.9). Median hospitalization rates in very low, low, moderate, high, and very high opportunity tracts were 9.1, 7.6, 4.6, 2.1, and 1.8 per 1000, respectively (P < .0001). The social/economic domain had the most variables significantly associated with the outcome at the population level. The adjusted patient-level analyses showed that the COI was not significantly associated with a patient's risk of rehospitalization within 12 months.The COI was associated with population-level asthma morbidity. The details provided by the COI may inform interventions aimed at increasing opportunity and reducing morbidity across regions.CONCLUSIONSThe COI was associated with population-level asthma morbidity. The details provided by the COI may inform interventions aimed at increasing opportunity and reducing morbidity across regions. To determine whether the Child Opportunity Index (COI), a nationally available measure of relative educational, health/environmental, and social/economic opportunity across census tracts within metropolitan areas, is associated with population- and patient-level asthma morbidity. This population-based retrospective cohort study was conducted between 2011 and 2013 in a southwest Ohio county. Participants included all children aged 1-16 years with hospitalizations or emergency department visits for asthma or wheezing at a major pediatric hospital. Patients were identified using discharge diagnosis codes and geocoded to their home census tract. The primary population-level outcome was census tract asthma hospitalization rate. The primary patient-level outcome was rehospitalization within 12 months of the index hospitalization. Census tract opportunity was characterized using the COI and its educational, health/environmental, and social/economic domains. Across 222 in-county census tracts, there were 2539 geocoded hospitalizations. The median asthma-related hospitalization rate was 5.0 per 1000 children per year (IQR, 1.9-8.9). Median hospitalization rates in very low, low, moderate, high, and very high opportunity tracts were 9.1, 7.6, 4.6, 2.1, and 1.8 per 1000, respectively (P < .0001). The social/economic domain had the most variables significantly associated with the outcome at the population level. The adjusted patient-level analyses showed that the COI was not significantly associated with a patient's risk of rehospitalization within 12 months. The COI was associated with population-level asthma morbidity. The details provided by the COI may inform interventions aimed at increasing opportunity and reducing morbidity across regions.
Author	Riley, Carley L. Lawson, Nikki R. Huang, Bin Kahn, Robert S. Beck, Andrew F. Wheeler, Kathryn
AuthorAffiliation	b Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A d Boston College, Chestnut Hills, Massachusetts, U.S.A a Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A e University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A c Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A f Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
AuthorAffiliation_xml	– name: e University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A – name: c Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A – name: d Boston College, Chestnut Hills, Massachusetts, U.S.A – name: b Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A – name: a Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A – name: f Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
Author_xml	– sequence: 1 givenname: Andrew F. orcidid: 0000-0002-4262-663X surname: Beck fullname: Beck, Andrew F. email: andrew.beck1@cchmc.org organization: Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH – sequence: 2 givenname: Bin surname: Huang fullname: Huang, Bin organization: Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH – sequence: 3 givenname: Kathryn orcidid: 0000-0003-3325-1407 surname: Wheeler fullname: Wheeler, Kathryn organization: Robert I. Morrissey College of Arts and Sciences, Boston College, Chestnut Hill, MA – sequence: 4 givenname: Nikki R. surname: Lawson fullname: Lawson, Nikki R. organization: University of Cincinnati College of Medicine, Cincinnati, OH – sequence: 5 givenname: Robert S. surname: Kahn fullname: Kahn, Robert S. organization: Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH – sequence: 6 givenname: Carley L. surname: Riley fullname: Riley, Carley L. organization: Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/29144247$$D View this record in MEDLINE/PubMed
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Snippet	To determine whether the Child Opportunity Index (COI), a nationally available measure of relative educational, health/environmental, and social/economic...
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SubjectTerms	Adolescent asthma Asthma - economics Asthma - epidemiology Asthma - etiology Asthma - therapy Child Child, Preschool Emergency Service, Hospital - statistics & numerical data Female Follow-Up Studies Health Status Disparities Hospitalization - statistics & numerical data Humans Infant Logistic Models Male Ohio - epidemiology pediatrics Retrospective Studies Risk Factors Social Class social determinants of health Urban Health - economics Urban Health - statistics & numerical data
Title	The Child Opportunity Index and Disparities in Pediatric Asthma Hospitalizations Across One Ohio Metropolitan Area, 2011-2013
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