Assessing the Impact of Neighborhood and Built Environment on Pediatric Perioperative Care: A Systematic Review of the Literature.

CONTEXT

Neighborhood and built environment encompass one key area of the Social Determinants of Health (SDOH) and is frequently assessed using area-level indices.

OBJECTIVE

We sought to systematically review the pediatric surgery literature for use of commonly applied area-level indices and to compare their utility for prediction of outcomes.

DATA SOURCES

A literature search was conducted using PubMed, Ovid MEDLINE, Ovid MEDLINE Epub Ahead of Print, PsycInfo, and an artificial intelligence search tool (1/2013-2/2023).

STUDY SELECTION

Inclusion required pediatric surgical patients in the US, surgical intervention performed, and use of an area-level metric.

DATA EXTRACTION

Extraction domains included study, patient, and procedure characteristics.

RESULTS

Area Deprivation Index is the most consistent and commonly accepted index. It is also the most granular, as it uses Census Block Groups. Child Opportunity Index is less granular (Census Tract), but incorporates pediatric-specific predictors of risk. Results with Social Vulnerability Index, Neighborhood Deprivation Index, and Neighborhood Socioeconomic Status were less consistent.

LIMITATIONS

All studies were retrospective and quality varied from good to fair.

CONCLUSIONS

While each index has strengths and limitations, standardization on ideal metric(s) for the pediatric surgical population will help build the inferential power needed to move from understanding the role of SDOH to building meaningful interventions towards equity in care.

TYPE OF STUDY

Systematic Review.

LEVEL OF EVIDENCE

Level III.