JMIR Publications

ABSTRACT

Background:

Publicly available public health tools such as the Area Deprivation Index (ADI), Child Opportunity Index (COI), and Social Vulnerability Index (SVI) are potential proxies for social determinants of health (SDOH), but evidence regarding their relationship with downstream health outcomes remains mixed.

Objective:

We sought to evaluate the relationship between emergency department utilization and inpatient encounters among pediatric brain or central nervous system (CNS) tumor patients by ADI, COI, and SVI.

Methods:

We conducted a retrospective cross-sectional study of pediatric brain and CNS tumor patients in Indiana from 2010 through 2020. We then fitted logistic, ordered logistic, and multilevel logistic regression models for emergency department (ED) visits and inpatient encounters to determine if there were associations between utilization and ADI, COI, or SVI. Finally, we overlaid index rankings onto maps to visually compare how indices characterized neighborhoods.

Results:

Out of 525 eligible patients, 264 (50.3%) had zero ED visits, 91 (17.3%) had one ED visit, and 170 (32.4%) had two or more ED visits. 73 (13.9%) patients had no hospitalizations, while 159 patients (30.3%) had one hospitalization, and 293 (55.8%) patients experienced multiple hospitalizations. Patients residing in moderate ADI neighborhoods experienced higher odds of any ED visits (aOR 2.42; 95% CI, 1.34–4.25) and multiple ED visits (aOR 2.02; 95% CI, 1.19–3.42). The COI and SVI were not associated with ED visits. Indices were not associated with inpatient visits. Additionally, we found that the ADI most likely to rank neighborhoods as very highly deprived.

Conclusions:

Indices provide useful context about the environment in which pediatric patients reside, but we found little evidence that indices are associated with health care utilization in our study population. Clinical Trial: null