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

Abstract

Purpose: Conduct an individual-level analysis of hospital utilization during the first year of life to test the hypothesis that community material deprivation increases healthcare utilization. Methods: We used a population-based perinatal data repository based on linkage of electronic health records (EHR) from regional delivery hospitals to subsequent hospital utilizations 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 utilizations during the first year of life. Results: After adjusting for any neonatal intensive care unit (NICU) 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% 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. Conclusions: Interventions designed to reduce material deprivation and income inequalities could significantly reduce infant hospital utilization.

Spatial analysis of inequalities in fetal and infant mortality due to avoidable causes

“…In maternal and infant health, the social deprivation index was used to test the hypothesis that material deprivation of the community increases the use of health services during the first year of life. A 10% increase in the social deprivation index caused an increase of 1,022 times in the risk of hospitalization and 1,032 times in the length of hospital stay (41) . By applying an indicator of social deprivation, Gonthie et al (2) showed that social deprivation was significantly associated with a higher risk of prenatal care.…”

“…Social deprivation should be taken into account in order to decrease infant mortality inequalities (39,42) . Yun et al (41) suggested establishing a regional perinatal assistance and medical emergency system in underprivileged regions, along with surveillance and monitoring of pregnant women and newborns in these regions. Improvement of living conditions and effective public policies are contributing factors towards decreasing these inequalities.…”

Neighborhood socioeconomic deprivation is associated with worse patient and graft survival following pediatric liver transplantation

“…Our primary exposure was a validated index of neighborhood socioeconomic deprivation. The index has a range of [0, 1] with values closer to 1 indicating more deprived neighborhoods. The neighborhood deprivation index was derived using data from the US Census Bureau's 2015 American Community Survey.…”

“…The deprivation index is available at the census tract level as well as at the ZIP code level . Intended to be a composite measure of neighborhood socioeconomic deprivation, the deprivation index is calculated from: fraction of the population below the federal poverty line, median household income, fraction of adults with a high school education, fraction of households receiving public assistance, fraction of the population with no health insurance, and fraction of housing units that are vacant . For the present analyses, the deprivation index was determined at the ZIP code level.…”

Triage in primary healthcare

“…Accurate triage will also avoid straining medical resources as it ensures the efficient use of resources. 22 The informants described that it was a challenge to triage elderly multimorbid patients as their needs were often complex. The proportion of severely ill elderly is increasing and the National Board of Health and Welfare 23 states that all healthcare professionals who encounter these patients should possess specific geriatric skills.…”