Place-based opportunity and well child visit attendance in early childhood

Authors

Jordan Tyris, Children's National Hospital, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC; Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD. Electronic address: jbarger@childrensnational.org.
Diane L. Putnick, Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
Kavita Parikh, Children's National Hospital, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC.
Tzu-Chun Lin, Glotech Inc., Bethesda, MD.
Rajeshwari Sundaram, Biostatistics and Bioinformatics Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
Edwina H. Yeung, Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.

Document Type

Journal Article

Publication Date

6-25-2024

Journal

Academic pediatrics

DOI

10.1016/j.acap.2024.06.012

Keywords

health disparities; health equity; social determinants of health; well child care

Abstract

BACKGROUND AND OBJECTIVES: Lower neighborhood opportunity, measured by the Child Opportunity Index [COI], is associated with increased pediatric morbidity, but is less frequently used to examine longitudinal well child care. We aimed to evaluate associations between the COI and well child visit [WCV] attendance from birth-<36 months of age. METHODS: The Upstate KIDS population-based birth cohort includes children born 2008-2010 in New York state. The exposure, 2010 census tract COI (very low [VL] to very high [VH]), was linked to children's geocoded residential address at birth. The outcome was attended WCVs from birth- <36 months of age. Parents reported WCVs and their child's corresponding age on questionnaires every 4-6 months. This data was applied to appropriate age ranges for recommended WCVs to determine attendance. Associations were modeled longitudinally as odds of attending visits and as mean differences in proportions of WCVs by COI. RESULTS: Among 4,650 children, 21% (n=977) experienced VL or low COI. Children experiencing VL (adjusted OR [aOR] 0.68, 95%CI 0.61, 0.76), low (aOR 0.81, 95%CI 0.73, 0.90), and moderate COI (aOR 0.88, 95%CI 0.81, 0.96), compared to VH COI, had decreased odds of attending any WCV. The estimated, adjusted mean proportions of WCV attendance were lower among children experiencing VL (0.45, p<.0001), low (0.53, p=0.002), moderate (0.53, p=0.0005), and high (0.54, p=0.03) compared to VH COI (0.56). CONCLUSIONS: Lower COI at birth was associated with decreased WCV attendance throughout early childhood. Reducing barriers to healthcare access for children experiencing lower COI may advance equitable well child care.

APA Citation

Tyris, Jordan; Putnick, Diane L.; Parikh, Kavita; Lin, Tzu-Chun; Sundaram, Rajeshwari; and Yeung, Edwina H., "Place-based opportunity and well child visit attendance in early childhood" (2024). GW Authored Works. Paper 5049.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5049

Department

Pediatrics