356 - Neighborhood Child Opportunity Index and Caregiver-Reported Healthcare Needs and Barriers

Publication Number: 4349.356

Reilly Dever, Seattle Children's Hospital, Seattle, WA, WA, United States; Chuan Zhou, Seattle Children's Research Institute, Seattle, WA, United States; Sumia Abdullahi, Seattle Childrens Hospital, Renton, WA, United States; Jocelyn Jimenez Romero, Seattle Children's, Seattle, WA, United States; Dean Karavite, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Nadege U.. Mudenge, The Children's Hospital of Philadelphia, Newark, DE, United States; Aditi Vasan, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Tracy J. Yang, University of Washington, Seattle Children's Hospital, Seattle, WA, United States; Elena C. Griego, University of Washington & Seattle Children's Hospital, Seattle, WA, United States; Katherine Yun, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; K. Casey Lion, Seattle Children's / University of Washington, Seattle, WA, United States

Background: Identifying hospitalized families likely to benefit from support services may ensure more effective resource distribution. The Child Opportunity Index (COI) is a readily available census tract-level composite measure of neighborhood conditions linked to child health outcomes. Understanding associations of COI with caregiver needs could inform targeted resource provision.

Objective: To evaluate associations between COI and caregiver-reported outcomes among publicly insured children.

Design/Methods: We conducted a cross-sectional analysis of surveys from caregivers enrolled in a larger randomized trial at two urban pediatric hospitals. Included caregivers were ≥18 years and spoke English, Spanish, Somali, or Vietnamese, with publicly insured children < 18 years admitted to a general pediatric service and of races/ethnicities other than non-Hispanic white. Validated surveys captured unmet social needs, housing concerns, barriers to care, negative hospital experiences, healthcare navigation ability, stress, and health literacy. State-normed COI was linked by census tract, then dichotomized into "Low" or "Very Low" COI vs. all others. Analyses included descriptive statistics overall and by site. Group comparisons used chi-squared/Fisher's exact tests for categorical and Wilcoxon/Kruskal-Wallis tests for continuous variables. We assessed associations between COI and dichotomized outcomes with logistic regression.

Results: Among 286 caregiver participants surveyed, 47% identified as Black and 39% Latino; 22% spoke languages other than English (Table 1). COI distribution differed by site, with families at site 1 living in higher opportunity COI neighborhoods than at site 2, on average (p < 0.001). COI was not associated with increased odds of reporting unmet social needs or housing concerns overall, but higher opportunity COI was associated with increased odds of reporting unmet needs and housing concerns at site 2 (Table 2, Figure 1). Higher opportunity COI was also associated with overall greater odds of negative hospital experiences and lower navigation ability. No associations were found with perceived stress or health literacy.

Conclusion(s): Among caregivers of Medicaid-insured children, higher opportunity COI was associated with more reported negative experiences and lower navigation ability, possibly reflecting that families of lower socioeconomic status in higher-opportunity neighborhoods do not experience all neighborhood advantages. COI may not further identify service needs among families already facing financial barriers; direct screening remains important.

Table 1: Participant Characteristics
Note: SD = standard deviation. Data reflects combined site 1 and site 2 unless otherwise indicated. Percentages may not sum to 100% due to missing data or rounding.

Table 2: Relationship of Caregiver-Reported Healthcare Needs and Barriers with State-Normed Child Opportunity Index
919AB3CF-8BE1-4DAA-BA63-4201403C5A0F_1_105_c.jpegNote: Odds ratios comparing "Low" or "Very Low" COI vs. all others.

Figure 1: Forest Plot of Odds Ratios for Association of Caregiver-Reported Healthcare Experiences and Social Needs with State-Normed Child Opportunity Index
Note: Data reflects combined site 1 and site 2. Odds ratios comparing "Low" or "Very Low" COI vs. all others.