Child Opportunity Index and Changes in Pediatric Acute Care Utilization in the COVID-19 Pandemic

Abstract

BACKGROUND Pediatric acute care utilization decreased dramatically during the COVID-19 pandemic. This study examined the association between the Child Opportunity Index (COI), a multidimensional neighborhood measure of childhood opportunity, and changes in acute care utilization at US pediatric hospitals during the COVID-19 pandemic compared to the prior three years. METHODS This observational study utilized administrative data across 41 US-based pediatric hospitals. Children 0-17 years with Emergency Department (ED) encounters during the study period were included. The COVID-19 pandemic time period (March 15, 2020-March 14, 2021) was the primary exposure. The primary outcome was the relative volume drop in ED encounters and observation/inpatient admissions through the ED by COI quintile. RESULTS Of 12,138,750 encounters, 3,705,320 (30.5%) were among the very low COI quintile. Overall, there was a 46.8% relative volume reduction in the pandemic period compared to the pre-pandmic period. This drop in volume occurred disproportionately among the very low COI quintile (51.1%) compared to very high COI quintile (42.8%). The majority of clinical diagnosis groups demonstrated larger relative volume drops among the very low COI quintile. CONCLUSIONS Acute care utilization decreased the most among children from very low COI neighborhoods, narrowing previously described acute care utilization disparities. Additional study of patient perspectives on health care needs and access during this period is required to understand these changes.

Effects of Sociodemographic and Child Opportunity Index on Pediatric Plastic and Oral and Maxillofacial Surgical Volume Trends in the COVID-19 Pandemic

“…Two studies assessing pediatric acute care utilization and elective surgical access during the early stages of the pandemic found that patients from the lowest COI level had the highest reduction in care compared with patients from higher COI levels,. 13,14 In contrast, another study found that families who were of a race other than White, spoke a language other than English, were publicly insured, and were from low COI levels had the highest hesitancy to seek care during COVID-19. 15 Current research depicts COI as an indicator for reduced care, aligning with the findings of this study that highlights COI as a possible predictor for reduced pediatric surgical care access.…”

Investigating the spatial accessibility and coverage of the pediatric COVID-19 vaccine: an ecologic study of regional health data

“…Percentage of household poverty was also negatively associated with school age vaccination rates which is consistent with previous work looking at vaccination coverage and healthcare utilization during the pandemic. 8,26…”

Associations between area-level health-related social factor indices and risk of acute COVID-19: An EHR-based cohort study from the RECOVER program

“…Health-related social factors. Geocoded PEDSnet EHR data were linked to data from two indices measuring neighborhood level socio-economic and environmental resources and exposures, the Area Deprivation Index (ADI) and the Child Opportunity Index (COI) (19,20) , at the Census block group level.…”