Stephens Caroline Q, Yap Ava, Vu Lan, Saito Jacqueline M, Barry Dwight, Shui Amy M, Cockrell Hannah, Cairo Sarah, Wakeman Derek, Berman Loren, Greenberg Sarah, Linden Allison F, Kohler Jonathan, Tsao KuoJen, Wilson Nicole A
University of California, San Francisco, San Francisco.
Children's National Hospital, Washington, District of Columbia.
JAMA Netw Open. 2024 Dec 2;7(12):e2449672. doi: 10.1001/jamanetworkopen.2024.49672.
Conclusions vary substantially among studies examining associations between area-based social determinants of health (SDOH) and pediatric health disparities based on the selected patient population and SDOH index. Most national studies use zip codes, which encompass a wide distribution of communities, limiting the generalizability of findings.
To characterize the distributions of composite SDOH indices for pediatric surgical patients within a national sample of academic children's hospitals and to assess SDOH index precision in classifying patients at similar levels of disadvantage.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter retrospective cohort study included patients younger than 18 years who underwent surgery from January 1, 2016, to December 31, 2021, at 8 American College of Surgeons National Surgical Quality Improvement Program Pediatric children's hospitals. Data were analyzed November 15, 2023, to September 25, 2024.
Exposures included the Social Vulnerability Index (SVI), Area Deprivation Index (ADI), and Child Opportunity Index (COI), which are composite scores of SDOH factors within a geographic area. A standardized, high-fidelity process was developed to link individual patients to SDOH indices at the US census tract and census block group level.
The primary outcome was composite SDOH index distribution, which was assessed using interrater reliability scores. Substantial agreement was defined as a Cohen κ statistic higher than 0.60.
Of 55 865 included patients, 54.6% were male; 34.8% were infants and toddlers (0-3 years of age), 39.0% were school age (4-12 years), and 26.2% were adolescents (13-17 years). A total of 3468 patients (6.2%) could not be matched to either an SVI, ADI, or COI. Patients with missing geocodes were more likely to be Hispanic (20.1% vs 17.1%; P < .001) and have Medicaid insurance (48.1% vs 44.6%; P < .001) compared with patients with addresses that could be geocoded. With all institutions grouped, SDOH indices showed only minor variations. However, within each institution and among institutions, indices varied considerably, especially the ADI. Indices had low-to-fair interrater reliability within institutions (κ range, 0.15-0.33), indicating that each index classified individual patients differently according to disadvantage.
In this multicenter retrospective cohort study of 55 865 pediatric surgical patients, 3 different composite measures of SDOH classified disadvantage for individual patients differently. The SDOH index components should be understood and carefully considered prior to inclusion of a composite measure in the analysis of children's surgical outcomes.
在研究基于地区的健康社会决定因素（SDOH）与基于所选患者群体和SDOH指数的儿科健康差异之间的关联时，各项研究的结论差异很大。大多数全国性研究使用邮政编码，其涵盖了广泛分布的社区，限制了研究结果的普遍性。
描述学术儿童医院全国样本中儿科手术患者综合SDOH指数的分布情况，并评估SDOH指数在对处于相似不利水平的患者进行分类时的准确性。
设计、设置和参与者：这项多中心回顾性队列研究纳入了2016年1月1日至2021年12月31日在美国外科医师学会国家外科质量改进计划儿科儿童医院接受手术的18岁以下患者。数据于2023年11月15日至2024年9月25日进行分析。
暴露因素包括社会脆弱性指数（SVI）、地区贫困指数（ADI）和儿童机会指数（COI），这些是地理区域内SDOH因素的综合得分。开发了一个标准化的、高保真的流程，将个体患者与美国人口普查区和普查街区组层面的SDOH指数相联系。
主要结局是综合SDOH指数分布，使用评分者间信度得分进行评估。实质性一致被定义为Cohen κ统计量高于0.60。
在纳入的55865例患者中，54.6%为男性；34.8%为婴幼儿（0至3岁），39.0%为学龄儿童（4至12岁），26.2%为青少年（13至17岁）。共有3468例患者（6.2%）无法与SVI、ADI或COI匹配。与地址可进行地理编码的患者相比，地理编码缺失的患者更可能是西班牙裔（20.1%对17.1%；P＜0.001）且拥有医疗补助保险（48.1%对44.6%；P＜0.001）。将所有机构归为一组时，SDOH指数仅显示出微小差异。然而，在每个机构内部以及机构之间，指数差异很大，尤其是ADI。各机构内指数的评分者间信度较低至中等（κ范围为0.15至0.33），这表明每个指数根据不利程度对个体患者的分类不同。
在这项对55865例儿科手术患者的多中心回顾性队列研究中，3种不同的SDOH综合测量方法对个体患者不利程度的分类不同。在将综合测量方法纳入儿童手术结局分析之前，应理解并仔细考虑SDOH指数的组成部分。
