Zolotor Anna, Huang Ro W, Bhavsar Nrupen A, Cholera Rushina
Trinity College of Arts & Sciences, Duke University.
Duke-Margolis Center for Health Policy.
medRxiv. 2023 Jul 3:2023.06.20.23291679. doi: 10.1101/2023.06.20.23291679.
Policymakers have increasingly utilized place-based social disadvantage indices to quantify the impacts of place on health and inform equitable resource allocation. Indices vary in design, content, and purpose but are often used interchangeably, potentially resulting in differential assignments of relative disadvantage depending on index choice.
To compare associations between three commonly used disadvantage indices (Social Vulnerability Index (SVI), Area Deprivation Index (ADI), and Child Opportunity Index (COI)) and two epidemiologically distinct child health outcomes-infant well-child check (WCC) attendance and adolescent obesity.
Cross-sectional analysis of Duke University Health System electronic health record (EHR) data from January 2014 to December 2019.
Children ≤18 years of age with outpatient encounters between January 2014 and December 2019, and who were Durham County residents were eligible. WCC attendance was assessed for infants ages 0-15 months; obesity was assessed for children ages 11-17 years.
2014 Social Vulnerability Index (SVI), 2015 Area Deprivation Index (ADI), and 2015 Child Opportunity Index (COI) 2.0.
Of 10175 patients in the WCC cohort, 20% (n = 2073) had less than six WCCs. Of 14961 patients in the obesity cohort, 20% (n = 2933) had obesity. All three indices were associated with both WCCs (OR for SVI 1.10, 95% CI 1.08-1.12; OR for ADI 1.10, 95% CI 1.08-1.12; OR for COI 1.12, 95% CI 1.10-1.14) and obesity (OR for SVI 1.05, 95% CI 1.04-1.08; OR for ADI 1.08, 95% CI 1.06-1.10; OR for COI 1.07, 95% CI 1.05-1.08).
Higher social disadvantage as defined by all three indices was similarly associated with both adolescent obesity and decreased infant WCC attendance. While the COI incorporates a broader set of child-specific variables, the SVI and ADI may often be just as suitable for pediatric research. Users should consider population and outcome characteristics when selecting an index.
政策制定者越来越多地利用基于地点的社会劣势指数来量化地点对健康的影响，并为公平的资源分配提供信息。这些指数在设计、内容和目的上各不相同，但经常被互换使用，这可能会根据指数的选择导致相对劣势的不同分配。
比较三种常用的劣势指数（社会脆弱性指数（SVI）、地区剥夺指数（ADI）和儿童机会指数（COI））与两种在流行病学上不同的儿童健康结果——婴儿健康检查（WCC）出勤率和青少年肥胖之间的关联。
对2014年1月至2019年12月杜克大学健康系统电子健康记录（EHR）数据进行横断面分析。
2014年1月至2019年12月期间有门诊就诊记录且为达勒姆县居民的18岁及以下儿童符合条件。对0至15个月大的婴儿进行WCC出勤率评估；对11至17岁的儿童进行肥胖评估。
2014年社会脆弱性指数（SVI）、2015年地区剥夺指数（ADI）和2015年儿童机会指数（COI）2.0。
1）婴儿WCC出勤率：在生命的前15个月内参加的WCC少于建议的最少6次；2）青少年肥胖：在最近一次就诊以及前9至36个月内的一次就诊时BMI均≥第95百分位数。
在WCC队列的10175名患者中，20%（n = 2073）的患者WCC次数少于6次。在肥胖队列的14961名患者中，20%（n = 2933）患有肥胖症。所有三个指数均与WCC出勤率（SVI比值比为1.10，95%置信区间为1.08 - 1.12；ADI比值比为1.10，95%置信区间为1.08 - 1.12；COI比值比为1.12，95%置信区间为1.10 - 1.14）和肥胖症（SVI比值比为1.05，95%置信区间为1.04 - 1.08；ADI比值比为1.08，95%置信区间为1.06 - 1.10；COI比值比为1.07，95%置信区间为1.05 - 1.08）相关。
所有三个指数所定义的较高社会劣势与青少年肥胖和婴儿WCC出勤率降低均有类似关联。虽然COI纳入了更广泛的一组特定于儿童的变量，但SVI和ADI通常可能同样适用于儿科研究。用户在选择指数时应考虑人群和结果特征。
