Neighborhood-Level Socioeconomic Disadvantage and Adverse Outcomes for Infants with Biliary Atresia in the United States.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 42492658.
- Also identified by DOI 10.1016/j.jpeds.2026.115252 and PMC identifier 13459466.
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Abstract
To examine the associations between child opportunity index (COI) and time to surgery as well as postoperative healthcare utilization for infants with biliary atresia undergoing Kasai hepatoportoenterostomy (HPE) in the USA. We conducted a retrospective cohort study of all infants with biliary atresia who underwent HPE within the Pediatric Health Information System database between 2014-2024. Our primary exposure was the COI, a composite measure of socioeconomic status at the ZIP code level. Primary outcomes were age at HPE in days; post-HPE length of stay (LOS); and hospital revisits (inpatient, observation, and emergency department) within two years post-HPE. We modeled median age at HPE using quantile regression, postoperative LOS using negative binomial regression, and revisits using Anderson-Gill recurrent event models with robust standard errors. We compared unadjusted models, models adjusted for race and ethnicity, and models adjusted for race and ethnicity as well as insurance status. Among 1,182 infants at 48 hospitals, median COI was 43 (Q1-Q3 20, 69) and median age at HPE was 56 days (Q1-Q3 38, 70). After adjustment, infants in the 20% most disadvantaged neighborhoods (very low COI) underwent HPE 8 days later than very high COI infants (β = 8.00, 95% CI 2.00-11.00, p=0.001). COI was not associated with postoperative LOS. Very low COI was associated with higher risk of all-cause readmission in the univariable model (HR 1.38, 95% CI 1.14-1.68, p=0.001) but lost significance in the model adjusted for race and ethnicity as well as insurance status (HR 1.22, 0.98-1.51, p=0.076). Although infants with biliary atresia from the most socioeconomically disadvantaged neighborhoods undergo HPE at later ages, neighborhood-level socioeconomic status was not associated with postoperative LOS or readmissions. Targeted interventions using the COI could improve timely access to surgical care for this vulnerable population.