Association of childhood opportunity with hospital-based reutilization in children with asthma.

Abstract

Outcome disparities exist among children with asthma, though associations between neighborhood conditions and timing and intensity (i.e., emergency department and readmissions) of recurrent hospital-based reutilization are not well defined. To evaluate associations between Childhood Opportunity Index (COI) and the intensity and timing of hospital-based reutilization for asthma. We studied children (2-17 years) from 47 US children's hospitals with an index admission for asthma from 2021 to 2022 using the Pediatric Health Information System database. The exposure was ZIP code-level COI 3.0 quintiles (very low to very high). The primary outcome was reutilization intensity (no reutilization, ≥1 emergency department revisit, 1 hospital readmission, and ≥2 hospital readmissions) across four time windows (30, 90, 180, and 365 days), evaluated using ordinal regression. Secondary analyses evaluated time to any reutilization using adjusted restricted mean survival time. Models were adjusted for patient demographics, complexity, distance-to-hospital, and severity of index admission. We identified 45,520 index admissions. At 90, 180, and 365 days, lower neighborhood opportunity was associated with higher reutilization intensity; differences widened over successive reutilization windows. Adjusted odds ratios for reutilization intensity in the lowest versus highest COI quintiles were 1.52 (1.36-1.70) at 90 days and 1.89 (1.74-2.06) at 365 days. The adjusted mean time to reutilization was 16 days shorter for the lowest versus highest COI quintile. Lower COI predicted earlier and more intense asthma-related hospital reutilization. The COI could help identify children with asthma who would benefit most from targeted interventions during a hospital-based visit to reduce future reutilization.