Purpose: Conduct an individual-level analysis of hospital utilization during the first year of life to test the hypothesis that community material deprivation increases healthcare utilization. Methods: We used a population-based perinatal data repository based on linkage of electronic health records (EHR) from regional delivery hospitals to subsequent hospital utilizations at the region's only dedicated children's hospital. Zero-inflated Poisson and Cox proportional hazards regression models were used to quantify the causal role of a census tract based deprivation index on the total number, length, and time until hospital utilizations during the first year of life. Results: After adjusting for any neonatal intensive care unit (NICU) admission, chronic complex conditions, race and ethnicity, insurance status, birth season, and very low birth weight we found that a 10% increase in the deprivation index caused a 1.032 fold increase (95% CI: [1.025, 1.040]) in post initial hospitalization length of stay, a 1.011 fold increase (95% CI: [1.002, 1.021]) in number of post initial hospital encounters, and 1.022 fold increase (95% CI: [1.009, 1.035]) in hazard for hospitalization utilization during the first year of life. Conclusions: Interventions designed to reduce material deprivation and income inequalities could significantly reduce infant hospital utilization.

BACKGROUND AND OBJECTIVES: Academic primary care clinics often care for children from underserved populations affected by food insecurity. Clinical-community collaborations could help mitigate such risk. We sought to design, implement, refine, and evaluate Keeping Infants Nourished and Developing (KIND), a collaborative intervention focused on food-insecure families with infants. METHODS: Pediatricians and community collaborators codeveloped processes to link food-insecure families with infants to supplementary infant formula, educational materials, and clinic and community resources. Intervention evaluation was done prospectively by using time-series analysis and descriptive statistics to characterize and enumerate those served by KIND during its first 2 years. Analyses assessed demographic, clinical, and social risk outcomes, including completion of preventive services and referral to social work or our medical-legal partnership. Comparisons were made between those receiving and not receiving KIND by using χ2 statistics. RESULTS: During the 2-year study period, 1042 families with infants received KIND. Recipients were more likely than nonrecipients to have completed a lead test and developmental screen (both P < .001), and they were more likely to have received a full set of well-infant visits by 14 months (42.0% vs 28.7%; P < .0001). Those receiving KIND also were significantly more likely to have been referred to social work (29.2% vs 17.6%; P < .0001) or the medical-legal partnership (14.8% vs 5.7%; P < .0001). Weight-for-length at 9 months did not statistically differ between groups. CONCLUSIONS: A clinical-community collaborative enabled pediatric providers to address influential social determinants of health. This food insecurity–focused intervention was associated with improved preventive care outcomes for the infants served.

Since late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people worldwide and resulted in more than 200,000 coronavirus disease 2019 (COVID-19) deaths. Emerging data suggest that elderly people as well as individuals with underlying health conditions are at a higher risk of hospitalization and death. 1-3 Interestingly, the Centers for Disease Control and Prevention's list of risk factors for severe COVID-19 (Fig 1) largely overlap with the list of diseases that are known to be worsened by chronic exposure to air pollution, including diabetes, heart diseases, and chronic airway diseases, such as asthma, lung cancer, and chronic obstructive pulmonary disease. 3 In this editorial, we highlight potential links between exposure to air pollution and COVID-19 severity, and we also hypothesize that disparate exposure to air pollution is one of the factors that contribute to the disproportionate impact COVID-19 is having on inner-city racial minorities. Air pollution is a complex mixture of particulate matter smaller than 2.5 or 10 mm (PM 2.5 , PM 10), nitric dioxide (NO 2), carbon monoxide (CO), ozone (O 3), and volatile organic compounds derived from vehicular traffic, industrial emissions, and indoor pollutants. Given overwhelming evidence linking chronic exposure to air pollution with increased morbidity and mortality across a range of cardiopulmonary diseases, 4 there is growing concern that air pollution may also contribute to COVID-19 severity, by directly affecting the lungs' ability to clear pathogens and indirectly by exacerbating underlying cardiovascular or pulmonary diseases. Such a link was reported during the 2003 SARS outbreak in China, where a positive association was observed between both acute and chronic pollution measures from the air pollution index (CO, NO 2 , SO 2 , O 3 , and PM 10) and SARS case-fatality rates. 5 Now, preliminary data are suggesting similar associations for COVID-19. In cities of China's Hubei province, the epicenter