The Child Opportunity Index measures the structural neighborhood context that may influence a child's healthy development. We examined relationships between the Child Opportunity Index and emergency department utilization. BACKGROUND AND OBJECTIVES The Child Opportunity Index (COI) is a multidimensional measure of structural neighborhood context that may influence a child's healthy development. Our objective was to determine if COI is associated with children's emergency department (ED) utilization using a national sample. METHODS This was a retrospective cohort study of the Pediatric Health Information Systems, a database from 49 United States children's hospitals. We analyzed children aged 0 to 17 years with ED visits from January 1, 2018, to December 31, 2019. We modeled associations between COI and outcomes using generalized regression models that adjusted for patient characteristics (eg, age, clinical severity). Outcomes included: (1) low-resource intensity (LRI) ED visits (visits with no laboratories, imaging, procedures, or admission), (2) ≥2 or ≥3 ED visits, and (3) admission. RESULTS We analyzed 6 810 864 ED visits by 3 999 880 children. LRI visits were more likely among children from very low compared with very high COI (1 LRI visit: odds ratio [OR] 1.35 [1.17-1.56]; ≥2 LRI visits: OR 1.97 [1.66-2.33]; ≥3 LRI visits: OR 2.4 [1.71-3.39]). ED utilization was more likely among children from very low compared with very high COI (≥2 ED visits: OR 1.73 [1.51-1.99]; ≥3 ED visits: OR 2.22 [1.69-2.91]). Risk of hospital admission from the ED was lower for children from very low compared with very high COI (OR 0.77 [0.65-0.99]). CONCLUSIONS Children from neighborhoods with low COI had higher ED utilization overall and more LRI visits, as well as visits more cost-effectively managed in primary care settings. Identifying neighborhood opportunity-related drivers can help us design interventions to optimize child health and decrease unnecessary ED utilization and costs.

中文翻译：

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邻里儿童机会和急诊科利用。

儿童机会指数衡量可能影响儿童健康发展的结构性邻里环境。我们检查了儿童机会指数与急诊科利用率之间的关系。背景和目标 儿童机会指数 (COI) 是对可能影响儿童健康发展的结构性邻里环境的多维测量。我们的目标是使用全国样本确定 COI 是否与儿童急诊科 (ED) 的使用有关。方法 这是一项对儿科健康信息系统的回顾性队列研究，该系统是来自美国 49 家儿童医院的数据库。我们分析了 2018 年 1 月 1 日至 2019 年 12 月 31 日期间就诊的 0 至 17 岁儿童。我们使用根据患者特征（例如年龄、临床严重程度）调整的广义回归模型对 COI 和结果之间的关联进行建模。结果包括：(1) 低资源强度 (LRI) 急诊就诊（没有实验室、影像学、程序或入院的就诊），（2）≥2 或≥3 次急诊就诊，以及（3）入院。结果 我们分析了 3 999 880 名儿童的 6 810 864 次急诊就诊。与非常高 COI 相比，LRI 就诊在非常低的儿童中更有可能（1 次 LRI 就诊：优势比 [OR] 1.35 [1.17-1.56]；≥2 次 LRI 就诊：OR 1.97 [1.66-2.33]；≥3 次 LRI 就诊：或 2.4 [1.71-3.39]）。与非常高 COI 相比，ED 使用率在非常低的儿童中更有可能（≥2 次 ED 就诊：OR 1.73 [1.51-1.99]；≥3 次 ED 就诊：OR 2.22 [1.69-2.91]）。与非常高 COI 相比，非常低的儿童从 ED 入院的风险较低（OR 0.77 [0.65-0.99]）。结论 来自低 COI 社区的儿童总体上 ED 利用率更高，LRI 就诊次数更多，并且在初级保健机构中的就诊管理更具成本效益。确定与邻里机会相关的驱动因素可以帮助我们设计干预措施以优化儿童健康并减少不必要的 ED 使用和成本。