Jawad Kahir, Feygin Yana B, Stevenson Michelle, Wattles Bethany A, Porter Jennifer, Jones V Faye, Davis Deborah Winders
Norton Children's Research Institute affiliated with the University of Louisville School of Medicine, Louisville, KY, USA.
University of Louisville School of Medicine, Department of Pediatrics, Louisville, KY, USA.
Pediatr Res. 2025 May 27. doi: 10.1038/s41390-025-04143-5.
Neighborhood advantage/disadvantage is a social determinant of health. We aimed to examine the distribution and associations between child chronic health conditions and four commonly used indices.
Children with outpatient visits and valid addresses (n = 115,738) were included and outcomes were categorized as having no chronic disease (N-CD), non-complex chronic disease (NC-CD), and complex chronic disease (C-CD). Four measures of neighborhood characteristics (Child Opportunity Index, Area Deprivation Index, Neighborhood Disadvantage Index, Social Vulnerability Index were calculated from census data. Separate multinomial logistic regression models were used.
The indices' scores were correlated (r = 0.80-0.92). Children in low opportunity or high disadvantage/deprivation/vulnerability neighborhoods were more likely to be diagnosed with C-CD than those in high opportunity or low disadvantage/deprivation/vulnerability neighborhoods. The increased odds ranged from 5% to 39%. The adjusted odds of NC-CD were found to increase by 8-31% as the neighborhood opportunity declined or the disadvantage/deprivation/vulnerability increased, across all indices. The association grew stronger as neighborhood opportunity decreased, or disadvantage/deprivation/vulnerability increased for all four indicators.
Each instrument was associated with medical complexity classifications, but the magnitude of the associations differed slightly. The rationale for choosing a measure of neighborhood characteristics should be based on the study's aims and population.
This study evaluates the associations of four commonly used neighborhood indices with medical complexity classifications. All indices were associated with study outcomes. The Area Disadvantage Index (ADI) and Child Opportunity Index (COI) demonstrated incremental increases in the odds of receiving a classification of complex chronic disease (C-CD) compared to no chronic disease (N-CD) as neighborhood opportunity decreased or the disadvantage/deprivation/vulnerability increased. Being classified with a non-complex chronic disease (NC-CD) compared to N-CD, only the association with the COI increased incrementally at each level of opportunity. Study outcomes and index characteristics must be considered when designing studies.
社区优势/劣势是健康的社会决定因素。我们旨在研究儿童慢性健康状况与四个常用指标之间的分布及关联。
纳入有门诊就诊记录且地址有效的儿童（n = 115,738），结局分为无慢性病（N-CD）、非复杂性慢性病（NC-CD）和复杂性慢性病（C-CD）。根据人口普查数据计算了四种社区特征指标（儿童机会指数、地区剥夺指数、社区劣势指数、社会脆弱性指数）。使用了单独的多项逻辑回归模型。
这些指标的得分具有相关性（r = 0.80 - 0.92）。与处于高机会或低劣势/剥夺/脆弱性社区的儿童相比，处于低机会或高劣势/剥夺/脆弱性社区的儿童更有可能被诊断为C-CD。增加的几率在5%至39%之间。在所有指标中，随着社区机会下降或劣势/剥夺/脆弱性增加，NC-CD的调整后几率增加8%至31%。随着社区机会减少或所有四个指标的劣势/剥夺/脆弱性增加，这种关联变得更强。
每种工具都与医疗复杂性分类相关，但关联程度略有不同。选择社区特征指标的依据应基于研究目的和人群。
本研究评估了四个常用社区指标与医疗复杂性分类之间的关联。所有指标均与研究结局相关。与无慢性病（N-CD）相比，随着社区机会减少或劣势/剥夺/脆弱性增加，地区劣势指数（ADI）和儿童机会指数（COI）显示出复杂性慢性病（C-CD）分类几率的逐步增加。与N-CD相比，被分类为非复杂性慢性病（NC-CD）时，仅与COI的关联在每个机会水平上逐步增加。设计研究时必须考虑研究结局和指标特征。
