In order to improve healthcare disparities, we need to first measure them before we can address them. Over the past few decades, the push to measure and address social determinants of health (SDOH) in pediatric practices and communities has created numerous measurement tools.
With the publication of the policy statement “Poverty and Child Health” in 2016, the American Academy of Pediatrics endorsed screening for and addressing child poverty on individual, community, and national policy levels. And while many pediatricians have adopted screening tools in practice, measuring entire neighborhood opportunity provides a more robust picture of place-based vulnerability and can be helpful for policy makers to address large-scale health equity. Unfortunately, multiple social disadvantage indices exist, each with different methodologies.
Fortunately, in an article being early released this week in Pediatrics, Anna Zolotor and colleagues from Duke University compare 3 of these indices (10.1542/peds.2023-064463):
- Childhood Opportunity Index
- CDC Social Vulnerability Index
- Area Deprivation Index
They compared associations between the 3 indices and 2 outcomes among children seen in the Duke University Health System:
- Infant well child check (WCC) attendance (ages 0–15 months)
- Adolescent obesity (11–17 years)
With very large study populations of 10175 and 14961 children in the WCC and obesity cohorts, respectively, the authors found that all 3 indices demonstrated associations between lower opportunity with worse outcomes—fewer WCC and greater obesity.
Overall, the authors conclude that the 3 indices may be equally suitable for pediatric research, but population and outcome characteristics should be considered when selecting an index, as there was some variability between them.
I would say that, similar to in-office screening for SDOH, this is good news. Not only do pediatricians have multiple options for in-office screening that have evidence of effectiveness, now researchers have 3 indices that can be used to address population-level disparities.
Moving forward, I would expect most child health outcome studies should start to incorporate social disadvantage indices as a variable in their studies. Fortunately, many large databases, such as the Pediatric Health Information System (PHIS), are including the childhood opportunity index (COI) for all the patients in the database, thus allowing for identification of neighborhood-level disparities for pediatric inpatient outcomes. Be on the lookout for future studies incorporating the COI and other indices to help us move the needle on healthcare disparities.
