Neighborhood Income Is Associated with Health Care Use in Pediatric Short Bowel Syndrome

Abstract

ObjectiveTo evaluate associations between neighborhood income and burden of hospitalizations for children with short bowel syndrome. Study designWe used the Pediatric Health Information System (PHIS) database to evaluate associations between neighborhood income and hospital readmissions, readmissions for central-line associated bloodstream infections (CLABSI), and hospital length of stay (LOS) for patients <18 years with SBS hospitalized between 1/1/2006 and 10/1/2015. We analyzed readmissions with recurrent event analysis and analyzed LOS with linear mixed effects modeling. We used a conceptual model to guide our multivariable analyses, adjusting for race, ethnicity, and insurance status. ResultsWe included 4,289 children with 16,347 hospitalizations from 43 institutions. Fifty-seven percent of the children were male, 21% were Black, 19% were Hispanic, and 67% had public insurance. In univariable analysis, children from low-income neighborhoods had a 38% increased risk for all-cause hospitalizations (rate ratio [RR] 1.38, 95% CI 1.10, 1.72, p=0.01), an 83% increased risk for CLABSI hospitalizations (RR 1.83, 95% CI 1.37, 2.44, p<0.001), and increased hospital LOS (β 0.15, 95% CI 0.01, 0.29, p=0.04). In multivariable analysis, the association between low-income neighborhoods and elevated risk for CLABSI hospitalizations persisted (RR 1.70, 95% CI 1.23, 2.35, p<0.01, respectively). ConclusionChildren with SBS from low-income neighborhoods are at increased risk for hospitalizations due to CLABSI. Examination of specific household- and neighborhood-level factors contributing to this disparity may inform equity-based interventions.