The Child Opportunity Index and Disparities in Pediatric Asthma Hospitalizations Across One Ohio Metropolitan Area, 2011-2013
The Child Opportunity Index and Disparities in Pediatric Asthma Hospitalizations Across One Ohio Metropolitan Area, 2011-2013
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DOI：
10.1016/j.jpeds.2017.08.007
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发表时间：
2017-11-01
影响因子：
5.1
通讯作者：
Riley, Carley L.
中科院分区：
文献类型：
--
作者：
Beck, Andrew F.;Huang, Bin;Riley, Carley L.
目的确定儿童机会指数（COI）是否与人口和患者哮喘发病率相关。儿童机会指数（COI）是一种全国可用的衡量大都市地区人口普查区相对教育、健康/环境和社会/经济机会的指标。这项基于人群的回顾性队列研究于2011年至2013年在俄亥俄州西南部的一个县进行。研究对象包括所有在大型儿科医院因哮喘或哮鸣住院或急诊就诊的1-16岁儿童。使用出院诊断代码对患者进行识别，并对其家庭人口普查区进行地理编码。主要人群水平结局为人口普查区哮喘住院率。患者水平的主要结局是在指数住院后12个月内再次住院。利用COI及其教育、卫生/环境和社会/经济领域，对人口普查区的机会进行了表征。结果222个县内人口普查区共有2539例地理编码住院。哮喘相关住院率中位数为每年每1000名儿童5.0人（IQR, 1.9-8.9）。极低、低、中等、高和极高机会区住院率中位数分别为9.1、7.6、4.6、2.1和1.8 / 1000 （P < 0.0001）。社会/经济领域与人口水平的结果显著相关的变量最多。调整后的患者水平分析显示，COI与患者在12个月内再次住院的风险无显著相关。结论COI与人群哮喘发病率相关。COI提供的细节可以为旨在增加机会和降低各区域发病率的干预措施提供信息。
Objectives To determine whether the Child Opportunity Index (COI), a nationally available measure of relative educational, health/environmental, and social/economic opportunity across census tracts within metropolitan areas, is associated with population-and patient-level asthma morbidity.Study design This population-based retrospective cohort study was conducted between 2011 and 2013 in a southwest Ohio county. Participants included all children aged 1-16 years with hospitalizations or emergency department visits for asthma or wheezing at a major pediatric hospital. Patients were identified using discharge diagnosis codes and geocoded to their home census tract. The primary population-level outcome was census tract asthma hospitalization rate. The primary patient-level outcome was rehospitalization within 12 months of the index hospitalization. Census tract opportunity was characterized using the COI and its educational, health/environmental, and social/economic domains.Results Across 222 in-county census tracts, there were 2539 geocoded hospitalizations. The median asthma-related hospitalization rate was 5.0 per 1000 children per year (IQR, 1.9-8.9). Median hospitalization rates in very low, low, moderate, high, and very high opportunity tracts were 9.1, 7.6, 4.6, 2.1, and 1.8 per 1000, respectively (P < .0001). The social/economic domain had the most variables significantly associated with the outcome at the population level. The adjusted patient-level analyses showed that the COI was not significantly associated with a patient's risk of rehospitalization within 12 months.Conclusions The COI was associated with population-level asthma morbidity. The details provided by the COI may inform interventions aimed at increasing opportunity and reducing morbidity across regions.