Material community deprivation and hospital utilization during the first year of life: an urban population–based cohort study

Abstract

PurposeThe purpose of the study was to conduct an individual-level analysis of hospital utilization during the first year of life to test the hypothesis that community material deprivation increases health care utilization. MethodsWe used a population-based perinatal data repository based on linkage of electronic health records from regional delivery hospitals to subsequent hospital utilization 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 utilization during the first year of life. ResultsAfter adjusting for any neonatal intensive care unit 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% confidence interval (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. ConclusionsInterventions designed to reduce material deprivation and income inequalities could significantly reduce infant hospital utilization.