Ramgopal Sriram, Kemal Samaa, Attridge Megan M, Crowe Remle, Martin-Gill Christian, Macy Michelle L
Division of Emergency Medicine (S Ramgopal, S Kemal, M Attridge, and M Macy), Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill; Stanley Manne Children's Research Institute (S Ramgopal, S Kemal, M Attridge, and M Macy), Chicago, Ill.
Division of Emergency Medicine (S Ramgopal, S Kemal, M Attridge, and M Macy), Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill; Stanley Manne Children's Research Institute (S Ramgopal, S Kemal, M Attridge, and M Macy), Chicago, Ill.
Acad Pediatr. 2025 Mar;25(2):102592. doi: 10.1016/j.acap.2024.10.004. Epub 2024 Oct 11.
Measures of neighborhood disadvantage demonstrate correlations to health outcomes in children. We compared differing indices of neighborhood disadvantage with emergency medical services (EMS) interventions in children.
We performed a retrospective study of EMS encounters for children (<18 years) from approximately 2000 US EMS agencies between 2021 and 2022. Our exposures were the Child Opportunity Index (COI; v2.0), 2021 Area Deprivation Index (ADI), and 2018 Social Vulnerability Index (SVI). We evaluated the agreement in how children were classified with each index using the intraclass correlation coefficient. We used logistic regression to evaluate the association of each index with transport status, presence of cardiac arrest, and condition-specific interventions and assessments.
We included 738,892 encounters. The correlation between the indices indicated good agreement (intraclass correlation coefficient=0.75). There was overlap in relationships between the COI, ADI, and SVI for each of the study outcomes, both when visualized as a splined predictor and when using representative odds ratios (OR) comparing the third quartile of each index to the lower quartile (most disadvantaged). For example, the OR of non-transport was 1.12 (95% confidence interval [CI]: 1.10-1.14) for COI, 1.18 (95% CI: 1.16-1.20) for ADI, and 1.22 (95% CI: 1.20-1.23) for SVI.
The COI, ADI, and SVI had good correlation and demonstrated similar effect size estimates for a variety of clinical outcomes. While investigators should consider potential causal pathways for outcomes when selecting an index for neighborhood disadvantage, the relative strength of association between each index and all outcomes was similar.
邻里劣势指标与儿童健康结果存在相关性。我们比较了不同的邻里劣势指标与儿童紧急医疗服务（EMS）干预情况。
我们对2021年至2022年期间来自美国约2000家EMS机构的18岁以下儿童的EMS接诊情况进行了回顾性研究。我们的暴露因素为儿童机会指数（COI；v2.0）、2021年地区贫困指数（ADI）和2018年社会脆弱性指数（SVI）。我们使用组内相关系数评估了各指数对儿童分类方式的一致性。我们使用逻辑回归来评估每个指数与转运状态、心脏骤停情况以及特定病情干预和评估之间的关联。
我们纳入了738,892次接诊情况。各指数之间的相关性显示出良好的一致性（组内相关系数=0.75）。对于每项研究结果，COI、ADI和SVI之间的关系存在重叠，无论是以样条预测器形式呈现，还是使用将每个指数的第三个四分位数与较低四分位数（最弱势）进行比较的代表性优势比（OR）时。例如，COI的非转运OR为1.12（95%置信区间[CI]：1.10 - 1.14），ADI为1.18（95% CI：1.16 - 1.20），SVI为1.22（95% CI：1.20 - 1.23）。
COI、ADI和SVI具有良好的相关性，并且对各种临床结果显示出相似的效应量估计。虽然研究人员在选择邻里劣势指数时应考虑结果的潜在因果途径，但每个指数与所有结果之间的关联相对强度相似。
