Child Opportunity Index and Changes in Pediatric Acute Care Utilization in the COVID-19 Pandemic

Cristin Q. Fritz, Division of Pediatric Hospital Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Eric W. Fleegler, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Heidi DeSouza, Children's Hospital Association, Lenexa, KS.
Troy Richardson, Children's Hospital Association, Lenexa, KS.
Sunitha V. Kaiser, Departments of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, CA.
Marion R. Sills, Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Colorado, Aurora, Colorado.
Jennifer N. Cooper, Nationwide Children's Hospital Research Institute, Columbus, OH.
Kavita Parikh, Department of Pediatrics, Children's National Hospital and The George Washington University, Washington, District of Columbia.
Henry T. Puls, Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.
Amy M. DeLaroche, Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
Alex H. Hogan, Division of Hospital Medicine, Connecticut Children's Medical Center, Hartford, CT.
Matthew S. Pantell, Department of Pediatric Hospital Medicine, University of California, San Francisco, CAS.
Aaron E. Kornblith, Division of Emergency Medicine, Department of Pediatrics, University of California, San Francisco, CA.
Kayla R. Heller, Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.
Michael T. Bigham, Department of Pediatrics, Akron Children's Hospital, Akron, OH.
Monika Goyal, Department of Pediatrics, Children's National Hospital and The George Washington University, Washington, District of Columbia.

Document Type

Journal Article

Publication Date

3-2-2022

Journal

Pediatrics

DOI

10.1542/peds.2021-053706

Abstract

BACKGROUND: Pediatric acute care utilization decreased dramatically during the COVID-19 pandemic. This study examined the association between the Child Opportunity Index (COI), a multidimensional neighborhood measure of childhood opportunity, and changes in acute care utilization at US pediatric hospitals during the COVID-19 pandemic compared to the prior three years. METHODS: This observational study utilized administrative data across 41 US-based pediatric hospitals. Children 0-17 years with Emergency Department (ED) encounters during the study period were included. The COVID-19 pandemic time period (March 15, 2020-March 14, 2021) was the primary exposure. The primary outcome was the relative volume drop in ED encounters and observation/inpatient admissions through the ED by COI quintile. RESULTS: Of 12,138,750 encounters, 3,705,320 (30.5%) were among the very low COI quintile. Overall, there was a 46.8% relative volume reduction in the pandemic period compared to the pre-pandmic period. This drop in volume occurred disproportionately among the very low COI quintile (51.1%) compared to very high COI quintile (42.8%). The majority of clinical diagnosis groups demonstrated larger relative volume drops among the very low COI quintile. CONCLUSIONS: Acute care utilization decreased the most among children from very low COI neighborhoods, narrowing previously described acute care utilization disparities. Additional study of patient perspectives on health care needs and access during this period is required to understand these changes.

Department

Pediatrics

Link to Full Text

Share

COinS