Cole Brokamp1, Andrew F Beck2, Neera K Goyal3, Patrick Ryan4, James M Greenberg5, Eric S Hall6. 1. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Electronic address: cole.brokamp@cchmc.org. 2. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Divisions of General and Community Pediatrics and Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 3. Department of Pediatrics, Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, PA; Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE. 4. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 5. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 6. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Abstract
PURPOSE: The purpose of the study was to conduct an individual-level analysis of hospital utilization during the first year of life to test the hypothesis that community material deprivation increases health care utilization. METHODS: We used a population-based perinatal data repository based on linkage of electronic health records from regional delivery hospitals to subsequent hospital utilization at the region's only dedicated children's hospital. Zero-inflated Poisson and Cox proportional hazards regression models were used to quantify the causal role of a census tract-based deprivation index on the total number, length, and time until hospital utilization during the first year of life. RESULTS: After adjusting for any neonatal intensive care unit admission, chronic complex conditions, race and ethnicity, insurance status, birth season, and very low birth weight, we found that a 10% increase in the deprivation index caused a 1.032-fold increase (95% confidence interval (CI), [1.025-1.040]) in post initial hospitalization length of stay, a 1.011-fold increase (95% CI, [1.002-1.021]) in number of post initial hospital encounters, and 1.022-fold increase (95% CI, [1.009-1.035]) in hazard for hospitalization utilization during the first year of life. CONCLUSIONS: Interventions designed to reduce material deprivation and income inequalities could significantly reduce infant hospital utilization.
PURPOSE: The purpose of the study was to conduct an individual-level analysis of hospital utilization during the first year of life to test the hypothesis that community material deprivation increases health care utilization. METHODS: We used a population-based perinatal data repository based on linkage of electronic health records from regional delivery hospitals to subsequent hospital utilization at the region's only dedicated children's hospital. Zero-inflated Poisson and Cox proportional hazards regression models were used to quantify the causal role of a census tract-based deprivation index on the total number, length, and time until hospital utilization during the first year of life. RESULTS: After adjusting for any neonatal intensive care unit admission, chronic complex conditions, race and ethnicity, insurance status, birth season, and very low birth weight, we found that a 10% increase in the deprivation index caused a 1.032-fold increase (95% confidence interval (CI), [1.025-1.040]) in post initial hospitalization length of stay, a 1.011-fold increase (95% CI, [1.002-1.021]) in number of post initial hospital encounters, and 1.022-fold increase (95% CI, [1.009-1.035]) in hazard for hospitalization utilization during the first year of life. CONCLUSIONS: Interventions designed to reduce material deprivation and income inequalities could significantly reduce infant hospital utilization.
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