Neighborhood Deprivation and Childhood Asthma Outcomes, Accounting for Insurance Coverage

Abstract

Neighborhood-level ADI measure is associated with asthma hospitalization outcomes. However, insurance coverage modifies this relationship and needs to be considered when using the ADI to identify and address health care disparities.

Adding a Vital Sign: Considering the Utility of Place-Based Measures in Health Care Settings

“…Children living in the more deprived areas, as defined by ADI quintiles, were generally more likely to experience longer lengths of stay, higher hospitalization costs, and greater likelihood of 6-month readmission than those living in less deprived areas. 10 These findings are similar to some of our own, which have illustrated analogous associations between area-level socioeconomic measures and adverse pediatric asthma outcomes. 1,12 Nkoy et al 10 went a step further in their assessment of potential interactions between area-level deprivation and patient-level insurance status.…”

“…In this issue' s article by Nkoy et al, 10 the authors completed a retrospective study in which they sought to assess whether the association between neighborhood-or area-level deprivation and key asthma-related outcomes among children hospitalized for exacerbations (length of stay, cost, readmission) would be modified by patient-level insurance status (ie, public versus private). The study included children aged 2 to 17 years who were hospitalized at any of 8 hospitals in Utah' s Intermountain Healthcare system.…”

“…For their area-level measure, the authors used the area of deprivation index (ADI). 10 The ADI includes geographic measures at the census block group level from the US Census that are related to education, employment, poverty, and housing. Intermountain Healthcare currently uses the ADI as a proxy measure to facilitate screening for a patient' s socioeconomic status and SDH-related risk factors.…”

“…In some cases, those with private insurance in more deprived areas experienced better outcomes than those with public insurance in less deprived areas, although the included analyses do not allow us to conclusively determine the significance of this finding. 10 A key strength of this study is that the authors make use of the robust data infrastructure available through Intermountain Healthcare. Intermountain is one of the first health care systems to insert an area-based measure, the ADI, into an EHR and then study its associations with outcomes in hospitalized children.…”

Neighborhood socioeconomic deprivation is associated with worse patient and graft survival following pediatric liver transplantation

“…Furthermore, we posited that insurance type is not a surrogate for SES but rather an indicator of access to healthcare services that may not be a reliable indicator in children with chronic disease . Therefore, we analyzed whether insurance status modified the effects of neighborhood deprivation on the outcomes, as previously demonstrated in asthma . Since complications within the first year of transplant are more likely to be related to surgical/medical management of the transplant itself, we performed sensitivity analyses that censored graft failure and death at 1 year after transplant.…”