TY - JOUR
T1 - Neighborhood deprivation and childhood asthma outcomes, accounting for insurance coverage
AU - Nkoy, Flory L.
AU - Stone, Bryan L.
AU - Knighton, Andrew J.
AU - Fassl, Bernhard A.
AU - Johnson, Joseph M.
AU - Maloney, Christopher G.
AU - Savitz, Lucy A.
N1 - Publisher Copyright:
© 2018 by the American Academy of Pediatrics.
PY - 2018/2
Y1 - 2018/2
N2 - OBJECTIVES: Collecting social determinants data is challenging. We assigned patients a neighborhoodlevel social determinant measure, the area of deprivation index (ADI), by using census data. We then assessed the association between neighborhood deprivation and asthma hospitalization outcomes and tested the influence of insurance coverage. METHODS: A retrospective cohort study of children 2 to 17 years old admitted for asthma at 8 hospitals. An administrative database was used to collect patient data, including hospitalization outcomes and neighborhood deprivation status (ADI scores), which were grouped into quintiles (ADI 1, the least deprived neighborhoods; ADI 5, the most deprived neighborhoods). We used multivariable models, adjusting for covariates, to assess the associations and added a neighborhood deprivation status and insurance coverage interaction term. RESULTS: A total of 2270 children (median age 5 years; 40.6% girls) were admitted for asthma. We noted that higher ADI quintiles were associated with greater length of stay, higher cost, and more asthma readmissions (P <.05 for most quintiles). Having public insurance was independently associated with greater length of stay (b: 1.171; 95% confidence interval [CI]: 1.117-1.228; P <.001), higher cost (b: 1.147; 95% CI: 1.093-1.203; P <.001), and higher readmission odds (odds ratio: 1.81; 95% CI: 1.46-2.24; P <.001). There was a significant deprivation-insurance effect modification, with public insurance associated with worse outcomes and private insurance with better outcomes across ADI quintiles (P <.05 for most combinations). CONCLUSIONS: Neighborhood-level ADI measure is associated with asthma hospitalization outcomes. However, insurance coverage modifies this relationship and needs to be considered when using the ADI to identify and address health care disparities.
AB - OBJECTIVES: Collecting social determinants data is challenging. We assigned patients a neighborhoodlevel social determinant measure, the area of deprivation index (ADI), by using census data. We then assessed the association between neighborhood deprivation and asthma hospitalization outcomes and tested the influence of insurance coverage. METHODS: A retrospective cohort study of children 2 to 17 years old admitted for asthma at 8 hospitals. An administrative database was used to collect patient data, including hospitalization outcomes and neighborhood deprivation status (ADI scores), which were grouped into quintiles (ADI 1, the least deprived neighborhoods; ADI 5, the most deprived neighborhoods). We used multivariable models, adjusting for covariates, to assess the associations and added a neighborhood deprivation status and insurance coverage interaction term. RESULTS: A total of 2270 children (median age 5 years; 40.6% girls) were admitted for asthma. We noted that higher ADI quintiles were associated with greater length of stay, higher cost, and more asthma readmissions (P <.05 for most quintiles). Having public insurance was independently associated with greater length of stay (b: 1.171; 95% confidence interval [CI]: 1.117-1.228; P <.001), higher cost (b: 1.147; 95% CI: 1.093-1.203; P <.001), and higher readmission odds (odds ratio: 1.81; 95% CI: 1.46-2.24; P <.001). There was a significant deprivation-insurance effect modification, with public insurance associated with worse outcomes and private insurance with better outcomes across ADI quintiles (P <.05 for most combinations). CONCLUSIONS: Neighborhood-level ADI measure is associated with asthma hospitalization outcomes. However, insurance coverage modifies this relationship and needs to be considered when using the ADI to identify and address health care disparities.
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U2 - 10.1542/hpeds.2017-0032
DO - 10.1542/hpeds.2017-0032
M3 - Article
C2 - 29317461
AN - SCOPUS:85052491539
SN - 2154-1663
VL - 8
SP - 59
EP - 67
JO - Hospital Pediatrics
JF - Hospital Pediatrics
IS - 2
ER -