Association of neighborhood opportunity and pediatric hospitalization rates in the United States

Abstract

We examined associations between a validated, multidimensional measure of social determinants of health and population‐based hospitalization rates among children <18 years across 18 states from the 2017 Healthcare Cost and Utilization Project State Inpatient Databases and the US Census. The exposure was ZIP code‐level Child Opportunity Index (COI), a composite measure of neighborhood resources and conditions that matter for children's health. The cohort included 614,823 hospitalizations among a population of 29,244,065 children (21.02 hospitalizations per 1000). Adjusted hospitalization rates decreased significantly and in a stepwise fashion as COI increased (p < .001 for each), from 26.56 per 1000 (95% confidence interval [CI] 26.41–26.71) in very low COI areas to 14.76 per 1000 (95% CI 14.66–14.87) in very high COI areas (incidence rate ratio 1.8; 95% CI 1.78–1.81). Decreasing neighborhood opportunity was associated with increasing hospitalization rates among children in 18 US states. These data underscore the importance of social context and community‐engaged solutions for health systems aiming to eliminate care inequities.