Association of Child Opportunity Index domains with emergency department disposition: analysis of a statewide sample.

Objective

The Child Opportunity Index (COI) is a composite measure designed to describe children's neighborhood resources and conditions, comprised of three domains: education, health & environment, and social & economic. We evaluated the association of COI, and its domains, with emergency department (ED) disposition.

Methods

We performed a cross-sectional analysis of all statewide ED encounters for pediatric patients (<18 years) in 2023. We developed multivariable logistic regression models to evaluate the association of COI and its domains with ED admissions and transfers. Models were adjusted for insurance status, race and ethnicity, age, diagnosis, medical complexity, and hospital type.

Results

There were 838,408 ED encounters in our sample; among these, 26,579 (3.2%) were admitted to the hospital and 18,130 (2.2%) were transferred. There was a U-shaped association between admission/transfer with COI and each of the three COI domains. When analyzed by diagnosis group, associations between COI and ED disposition varied, with low and high measures positively associated with this outcome. The social and economic domain demonstrated the best relative model fit in most models.

Conclusions

Patients with both the lowest and highest COI experience higher odds of ED admission and/or transfer; this distribution was also noted for analyses incorporating the three domains of COI. The social and economic domain was the most consistent predictor. Understanding how differing aspects of the COI are associated with pediatric outcomes can improve interpretation of the index, clarify which domains are most meaningful, and support its more precise use in pediatric health research and risk assessment.