Examining housing insecurity and transportation barriers in pediatric hospital readmissions: insights from structured and unstructured data.

Abstract

Pediatric hospital readmissions increase healthcare costs and highlight gaps in care. Social determinants of health (SDOH), such as housing and transportation insecurity, significantly impact outcomes but are underexplored in pediatric populations. This study evaluates the impact of housing and transportation-related SDOH on pediatric readmissions, comparing structured ICD-10-CM Z-codes alone to a combination of structured and unstructured data extracted via natural language processing (NLP). We conducted a retrospective cohort study of pediatric patients (ages 2-17) discharged from UCSF Benioff Children's Hospital between January 2018 and January 2023. SDOH exposure was identified using structured Z-codes and NLP-extracted data. The primary outcome was hospital readmission within 365 days. Cox proportional hazards models assessed associations between SDOH and readmission risk. Among 8928 patients, only 0.8% were identified as exposed using structured data, compared to 31.7% using combined data. Patients identified through combined data had a higher readmission risk (HR: 2.64, 95% CI: 2.34-2.98) compared to those identified with structured data alone (HR: 1.99, 95% CI: 1.27-3.13). ED utilization was also higher among exposed patients. In the structured-only analysis, exposed patients had a significantly higher hazard of ED readmission (HR: 2.26, 95% CI: 1.65-3.10), whereas the association was slightly attenuated in the combined analysis (HR: 1.49, 95% CI: 1.37-1.62). Leveraging unstructured data enhances SDOH identification and reveals stronger associations with hospital and ED readmissions. A hybrid approach enables improved risk stratification and targeted interventions to address pediatric health disparities.