The Association of Mobility, Social Deprivation, and Pediatric Primary Care Outcomes in Community Health Centers

Abstract

To examine how social deprivation and residential mobility are associated with primary care use in children seeking care at community health centers (CHCs) overall and stratified by race and ethnicity. We used electronic health record open cohort data from 152 896 children receiving care from 15 US CHCs belonging to the OCHIN network. Patients were aged 3-17years, with ≥2 primary care visits during 2012-2017 and had geocoded address data. We used negative binomial regression to calculate adjusted rates of primary care encounters and influenza vaccinations relative to neighborhood-level social deprivation. Higher rates of clinic utilization were observed for children who always lived in highly deprived neighborhoods (RR=1.11, 95% CI=1.05-1.17) and those who moved from low-to-high deprivation neighborhoods (RR=1.05, 95% CI=1.01-1.09) experienced higher rates of CHC encounters compared with children who always lived in the low-deprivation neighborhoods. This trend was similar for influenza vaccinations. When analyses were stratified by race and ethnicity, we found these relationships were similar for Latino children and non-Latino White children who always lived in highly deprived neighborhoods. Residential mobility was associated with lower rates of primary care. These findings suggest that children living in or moving to neighborhoods with high levels of social deprivation used more primary care CHC services than children who lived in areas with low deprivation, but moving itself was associated with less care. Clinician and delivery system awareness of patient mobility and its impacts are important to addressing equity in primary care.