31: CHILDHOOD OPPORTUNITY INDEX AMONG CRITICALLY ILL CHILDREN: A MULTICENTER, RETROSPECTIVE COHORT STUDY

Abstract

Introduction: Children from impoverished neighborhoods have increased likelihood of severity of illness and pediatric intensive care unit (PICU) admission. Existing metrics to score environmental influences do not account for the diverse range of factors that could impact child health. The Childhood Opportunity Index (COI), a metric of local and regional neighborhood factors, highlights social disparities that impact childhood wellbeing. We sought to characterize COI among critically ill children and explore for potential relationships between COI and poor clinical outcomes. Methods: We performed a retrospective, multicenter cohort study including children (< 18 years) admitted to 47 PICUs from January 2018 through December 2019 using the Pediatric Hospital Information System registry. COI for each patient encounter was characterized by demographic data including race and United States Census Geographic Regions. For exploratory modelling, clinical outcomes were index mortality and hospital length of stay (LOS). Descriptive, comparative (chi-square, ANOVA, and Kruskal-Wallis tests), and associative (logistic/linear modelling) statistics were employed. Results: Of the 26,912 children studied, 44.8% resided in low or very low COI neighborhoods. Hispanic and Black children more frequently resided in very low COI areas (35.4% and 47.7%, respectively) as compared to White (15.7%), Asian (10.7%), and Pacific Islander (11.5%) children. COI varied by region with the East South-Central region having the greatest frequency of critically ill children from very low (27.1%) and low (28.5%) COI neighborhoods. The New England region showed the greatest proportion of PICU encounters from very high COI areas (35.5%) (p < 0.001). Exploratory models found COI to be inversely associated with mortality (odds ratio 0.91, 95% confidence interval 0.85-0.96) and LOS (p < 0.001). Conclusions: This large, multicenter study revealed racial and geographic variation in COI among hospitalized critically ill children. Those residing in lower COI neighborhoods experienced a greater risk of mortality and prolonged LOS. Our findings suggest that utilization of COI in identifying potentially modifiable environmental factors can inform public health initiatives and further research towards reducing health inequity.