Patients in low-opportunity neighborhoods fall behind on preventive care

According to a recent study published in JAMA Network Open, pediatric patients in low-opportunity neighborhoods experience worsened primary care outcomes.

Health outcomes, educational attainment, and economic success as adults are all impacted long-term by health inequities during childhood. Along with individual and sociodemographic inequities, this includes environmental factors.

In recent analyses, area-level socioeconomic factors have been directly associated with inequities in pediatric preventive care. Positive and negative factors of neighborhood conditions may be assessed using the Childhood Opportunity Index (COI). The COI includes 29 items across education, health and environment, and social and economic context domains.

To evaluate the association between COI and pediatric preventive care access, investigators conducted a retrospective, cross-sectional, observational study. Data was obtained from electronic health recordsof the Children’s Hospital of Philadelphia primary care network, including over 300,000 patients across 31 pediatric primary care clinics.

Participants were aged 0 to 19 years and active in the care network between November 2020 and November 2022. Criteria for being active included undergoing at least 1 primary care clinician visit within the previous 2 years. Exclusion criteria included missing address information, COI data, or demographic information.

The primary exposure of the analysis was COI version 2.0, which is measured at the census tract level and covers nation, state, and metropolitan areas. Domain-specific opportunity levels for the 3 domains were evaluated in a secondary analysis.

Census tracts with scores of the 20th percentile or less were considered very low, above the 20th and through the 40th low, above the 40th and through the 60th moderate, above the 60th and through the 80th high, and above the 80th very high.

Outcomes included adherence to American Academy of Pediatrics preventive care guidelines, obesity, and adolescent and maternal mental health screening results for depressive symptoms and risk of suicide. Covariates included sex, race and ethnicity, age, and payer type.

There were 338,277 pediatric patients included in the analysis, aged a mean 9.8 years. Of patients, 48.8% were female, 46.7% non-Hispanic White, and 61.9% commercially insured. 

The COI level was very lowfor 24.2%, moderate for 10.7%, and very highfor 38.5%. Residence in a very low or low COI level neighborhood was more likely in non-Hispanic Black and publicly insured patients.

The percentage of children with more favorable outcomes corresponded with neighborhood COI, with the percentage of children up to date on preventive visits being 62.2% in very low opportunity neighborhoods and 75.5% in very high opportunity neighborhoods. Being up to date on immunizations were seen in 52.3% and 83.1% of these groups respectively.

In the very low opportunity group, 25.8% of children were obese, compared to 10% in the very high opportunity group. Positive screening for moderate-to-severe depression symptoms was seen in 12.9% and 8% of these groups respectively, with similar patterns for suicide risk.

These results indicated a direct association between COI level and preventive care metrics. Investigators concluded it is important to improve access to pediatric preventive care in low COI neighborhoods.

Reference

Ramachandran J, Mayne SL, Kelly MK, et al. Measures of neighborhood opportunity and adherence to recommended pediatric primary care. JAMA Netw Open. 2023;6(8):e2330784. doi:10.1001/jamanetworkopen.2023.30784