The Association of the Childhood Opportunity Index on Pediatric Readmissions and Emergency Department Revisits

Jessica L. Bettenhausen, Clemens Noelke, Robert W. Ressler, Matthew Hall, Mitch Harris, Alon Peltz, Katherine A. Auger, Ronald J. Teufel, Jeffrey E. Lutmer, Molly K. Krager, Harold K. Simon, Mark I. Neuman, Padmaja Pavuluri, Rustin B. Morse, Pirooz Eghtesady, Michelle L. Macy, Samir S. Shah, David C. Synhorst, James C. Gay

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Objective: Reutilization following discharge is costly to families and the health care system. Singular measures of the social determinants of health (SDOH) have been shown to impact utilization; however, the SDOH are multifactorial. The Childhood Opportunity Index (COI) is a validated approach for comprehensive estimation of the SDOH. Using the COI, we aimed to describe the association between SDOH and 30-day revisit rates. Methods: This retrospective study included children 0 to 17 years within 48 children's hospitals using the Pediatric Health Information System from 1/1/2019 to 12/31/2019. The main exposure was a child's ZIP code level COI. The primary outcome was unplanned readmissions and emergency department (ED) revisits within 30 days of discharge. Primary outcomes were summarized by COI category and compared using chi-square or Kruskal-Wallis tests. Adjusted analysis used generalized linear mixed effects models with adjustments for demographics, clinical characteristics, and hospital clustering. Results: Of 728,997 hospitalizations meeting inclusion criteria, 30-day unplanned returns occurred for 96,007 children (13.2%). After adjustment, the patterns of returns were significantly associated with COI. For example, 30-day returns occurred for 19.1% (95% confidence interval [CI]: 18.2, 20.0) of children living within very low opportunity areas, with a gradient-like decrease as opportunity increased (15.5%, 95% CI: 14.5, 16.5 for very high). The relative decrease in utilization as COI increased was more pronounced for ED revisits. Conclusions: Children living in low opportunity areas had greater 30-day readmissions and ED revisits. Our results suggest that a broader approach, including policy and system-level change, is needed to effectively reduce readmissions and ED revisits.

Original languageEnglish
Pages (from-to)614-621
Number of pages8
JournalAcademic Pediatrics
Issue number4
StatePublished - May 1 2022


  • readmissions
  • reutilization
  • social determinants of health


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