The Child Opportunity Index and Children's Health: A Meta-Analysis

Authors

Jordan Tyris, Children's National Hospital, Washington, DC.
Diane L. Putnick, Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
Susan Keller, Children's National Hospital, Washington, DC.
Kavita Parikh, Children's National Hospital, Washington, DC.
Edwina H. Yeung, Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.

Document Type

Journal Article

Publication Date

4-1-2025

Journal

Pediatrics

Volume

155

Issue

4

DOI

10.1542/peds.2024-067873

Abstract

CONTEXT: Quantifying the impact of place on pediatric health is difficult given the diverse methodologies used to measure place-based social determinants. However, the Child Opportunity Index (COI) is increasingly used to study these relationships. OBJECTIVE: To synthesize associations between the COI and pediatric health. DATA SOURCES: Fifteen databases, 4 gray literature sources, and diversitydatakids.org searched from 2014 to 2024. STUDY SELECTION: US-based observational studies that evaluated children, the COI, and at least 1 pediatric health outcome. DATA EXTRACTION: Protocol registered with PROSPERO (CRD42023418407). Random-effects models created pooled odds ratios (ORs) comparing very low/low COI to high/very high COI for mortality, emergency department (ED) use, and hospital use. Clinically relevant subgroups were explored. RESULTS: Most studies (n = 61 of 85; 72%) reported inverse associations between the COI and an adverse outcome. Lower COI was associated with higher odds of mortality (OR, 1.50; 95% CI, 1.31-1.94; tau squared [τ2] = 0.045; 15 associations from 13 studies). Overall, ED visits were similar (OR, 1.38; 95% CI, 0.97-1.95; τ2 = 0.312; 10 associations from 6 studies), but the subgroup of all-cause ED visits were significantly higher among children with lower COI (OR, 1.66; 95% CI, 1.19-2.31; τ2 = 0.198; 7 associations from 5 studies). Select hospitalization subgroups (medical, surgical/trauma, and >30-day rehospitalizations) were significantly associated with COI, but not overall hospitalizations (OR, 1.15; 95% CI, 0.96-1.36; τ2 = 0.090; 12 studies). LIMITATIONS: Meta-analyses were unadjusted. CONCLUSIONS: Place is a risk factor for children's mortality and select measures of health care use. Shifting the focus from identifying place-based disparities to cocreating community-engaged strategies that mitigate disparities may effectively advance children's health equity.

APA Citation

Tyris, Jordan; Putnick, Diane L.; Keller, Susan; Parikh, Kavita; and Yeung, Edwina H., "The Child Opportunity Index and Children's Health: A Meta-Analysis" (2025). GW Authored Works. Paper 7139.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7139

Department

Pediatrics