Neighborhood child opportunity and its association with complicated inguinal hernia in children: an analysis of a national insurance claims-based database.

BACKGROUND

The Child Opportunity Index (COI) is a measure of neighborhood conditions associated with healthy child development. Inguinal hernia repair (IHR) is a common pediatric procedure. We sought to evaluate the association between COI and complicated inguinal hernia (IH), incarcerated or strangulated IH, among children with employer-based insurance coverage.

METHODS

We performed a retrospective cohort study of children who underwent IHR in the IBM Watson Health MarketScan Research Database from 2015 to 2019. Claims data were merged with the COI at the metropolitan statistical area (MSA) level. We performed a multivariate regression analysis to determine the association between COI and complicated IH.

RESULTS

A total of 12,084 eligible pediatric patients were identified, of which 3.7%(n = 408) had IH. Children with complicated IH were younger than those with uncomplicated IH (2 vs. 3 years; p = 0.0016). There were no children from very low COI neighborhoods. There was no difference in COI between uncomplicated and complicated IH: (Low- 13.5% vs. 17.2%: Moderate- 67.3% vs. 63.5%; High- 19.2% vs. 19.4%; p = 0.19). Age (aOR: 0.967; 95% CI: 0.95-0.99), but not COI, was independently associated with decreased odds of complicated IH.

CONCLUSION

Neighborhood-level disadvantage, as measured by COI 2.0, was not an independent predictor of complicated IH among children with employer-based insurance coverage.

LEVEL OF EVIDENCE

II.