Attridge Megan M, Heneghan Julia A, Akande Manzilat, Ramgopal Sriram
Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine (MM Attridge and S Ramgopal), Chicago, Ill.
Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital; University of Minnesota (JA Heneghan), Minneapolis, Minn.
Acad Pediatr. 2023 Jul;23(5):980-987. doi: 10.1016/j.acap.2023.01.006. Epub 2023 Jan 20.
Child health and development is influenced by neighborhood context. The Child Opportunity Index (COI) is a multidimensional measure of neighborhood conditions. We sought to evaluate the association of COI with mortality among children presenting to the emergency department (ED).
We performed a multicenter cross-sectional study of pediatric (<18 years) ED encounters from a statewide dataset from 2016 to 2020. We constructed a multivariable logistic regression model to evaluate the association between COI and in-hospital mortality after adjusting for sociodemographic characteristics and medical complexity.
Among 4,653,070 included encounters, in-hospital mortality occurred in 1855 (0.04%). There was a higher proportion of encounters with mortality in the lower COI categories relative to the higher COI categories (0.053%, 0.038%, 0.031%, 0.034%, 0.034% ranging from Very Low to Very High, respectively). In adjusted models, child residence in Low (adjusted odds ratio 1.26; 95% confidence interval [CI], 1.04-1.53) and Very Low (adjusted odds ratio 1.58; 95% CI, 1.31-1.90) COI neighborhoods was associated with mortality relative to residence in Very High COI neighborhoods. This association was noted across all domains of COI (education, health and environment, and social and economic), using an expanded definition of mortality, using nationally normed COI, and excluding patients with complex chronic conditions. Other factors associated with increased odds of mortality included age, medical complexity, payor status, age, and race and ethnicity.
Understanding the association of neighborhood context on child mortality can inform public health interventions to improve child mortality rates and reduce disparities.
儿童健康与发育受邻里环境影响。儿童机会指数（COI）是对邻里环境状况的多维度衡量指标。我们试图评估COI与到急诊科（ED）就诊儿童死亡率之间的关联。
我们对2016年至2020年来自全州数据集的儿科（<18岁）ED就诊情况进行了多中心横断面研究。我们构建了一个多变量逻辑回归模型，以评估在调整社会人口学特征和医疗复杂性后，COI与住院死亡率之间的关联。
在纳入的4653070次就诊中，1855例（0.04%）发生了住院死亡。与COI较高类别相比，COI较低类别中死亡就诊的比例更高（分别从极低到极高，比例为0.053%、0.038%、0.031%、0.034%、0.034%）。在调整后的模型中，与居住在COI非常高的社区相比，居住在COI低（调整后的比值比为1.26；95%置信区间[CI]，1.04 - 1.53）和极低（调整后的比值比为1.58；95%CI，1.31 - 1.90）社区的儿童与死亡率相关。使用COI的扩展定义、全国标准化的COI以及排除患有复杂慢性病的患者后，在COI的所有领域（教育、健康与环境以及社会与经济）均观察到了这种关联。与死亡几率增加相关的其他因素包括年龄、医疗复杂性、支付者状态、年龄以及种族和族裔。
了解邻里环境与儿童死亡率之间的关联可为公共卫生干预措施提供信息，以提高儿童死亡率并减少差异。
