The Child Opportunity Index and Disparities in Pediatric Asthma Hospitalizations Across One Ohio Metropolitan Area, 2011-2013

Abstract

Objectives To determine whether the Child Opportunity Index (COI), a nationally-available measure of relative educational, health/environmental, and social/economic opportunity across census tracts within metropolitan areas, was associated with population- and patient-level asthma morbidity. Study design This population-based retrospective cohort study was conducted between 2011–2013 in 1 Southwest Ohio county. Participants included all children, 1–16 years, with hospitalizations or emergency department visits for asthma or wheezing at a major pediatric hospital. Patients were identified using discharge diagnosis codes and geocoded to their home census tract. The primary population-level outcome was census tract asthma hospitalization rate. The primary patient-level outcome was re-hospitalization within 12 months of index hospitalization. Census tract opportunity was characterized using the COI and its educational, health/environmental, and social/economic domains. Results Across 222 in-county census tracts, there were 2,539 geocoded hospitalizations. The median asthma-related hospitalization rate was 5.0 per 1,000 children per year (interquartile range: 1.9–8.9). Median hospitalization rates in very low, low, moderate, high, and very high opportunity tracts were 9.1, 7.6, 4.6, 2.1, and 1.8 per 1,000, respectively (P < .0001). The social/economic domain had the most variables significantly associated with the outcome at the population level. The adjusted patient-level analyses showed that the COI was not significantly associated with a patient’s risk of re-hospitalization within 12 months. Conclusions The Child Opportunity Index was associated with population-level asthma morbidity. The detail provided by the COI may inform interventions aimed at increasing opportunity and reducing morbidity across regions.

African American Breastfeeding Peer Support: All Moms Empowered to Nurse

“…A total of 67 AMEN meetings have occurred to date, initially once or twice a month in person, but subsequently modified to weekly online meetings. Attendance has varied in number and scope, but an average of 10 mothers (range [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] have attended the meetings for a 3.4 year period ( Fig. 1).…”

“…Considering these obstacles, identifying mothers early in their need for breastfeeding support, and connecting them promptly with appropriate and accessible breastfeeding resources, represents a potential way to increase breastfeeding success. As higher levels of socioeconomic deprivation have been associated with adverse health outcomes, 9,10 disparities in breastfeeding continuation must be addressed to improve overall health and health equity. Importantly, increased breastfeeding is associated with decreased infant mortality, 11,12 which is extremely high in Hamilton County, especially in the African American population and in neighborhoods of poverty.…”

Resilience-promoting policies and contexts for children of color in the United States: Existing research and future priorities

“…According to this metric, in the 100 largest metropolitan areas in the United States in 2015, one in five White and Asian children live in communities characterized as high or very high opportunity, while two-thirds of African American children and more than half of Latino and Native American children live in low- or very low-opportunity neighborhoods (i.e., 67%, 58%, and 53%, respectively) (Acevedo-Garcia et al, 2020). Research shows that the Child Opportunity Index is related to child health outcomes and acute care use (Beck et al, 2017; Kersten et al, 2018); therefore, these disparities in neighborhood opportunity by race and ethnicity illustrate the importance of place-based interventions as a strategy to improve life opportunities for children of color.…”

Pediatric Pulmonology year in review 2017: Part 3

“…Beck et al sought to determine whether the Child Opportunity Index (COI), a measure of relative educational, health/environmental, and social/economic opportunity across census tracts within metropolitan areas, is associated with population‐ and patient‐level asthma morbidity. This retrospective cohort study was conducted between 2011 and 2013 in a southwest Ohio county.…”