The association between four neighborhood disadvantage indices and child chronic health classifications.

Abstract

Background: Neighborhood advantage/disadvantage is a social determinant of health. We aimed to examine the distribution and associations between child chronic health conditions and four commonly used indices.

Methods: Children with outpatient visits and valid addresses (n = 115,738) were included and outcomes were categorized as having no chronic disease (N-CD), non-complex chronic disease (NC-CD), and complex chronic disease (C-CD). Four measures of neighborhood characteristics (Child Opportunity Index, Area Deprivation Index, Neighborhood Disadvantage Index, Social Vulnerability Index were calculated from census data. Separate multinomial logistic regression models were used.

Results: The indices' scores were correlated (r = 0.80-0.92). Children in low opportunity or high disadvantage/deprivation/vulnerability neighborhoods were more likely to be diagnosed with C-CD than those in high opportunity or low disadvantage/deprivation/vulnerability neighborhoods. The increased odds ranged from 5% to 39%. The adjusted odds of NC-CD were found to increase by 8-31% as the neighborhood opportunity declined or the disadvantage/deprivation/vulnerability increased, across all indices. The association grew stronger as neighborhood opportunity decreased, or disadvantage/deprivation/vulnerability increased for all four indicators.

Conclusions: Each instrument was associated with medical complexity classifications, but the magnitude of the associations differed slightly. The rationale for choosing a measure of neighborhood characteristics should be based on the study's aims and population.

Impact: This study evaluates the associations of four commonly used neighborhood indices with medical complexity classifications. All indices were associated with study outcomes. The Area Disadvantage Index (ADI) and Child Opportunity Index (COI) demonstrated incremental increases in the odds of receiving a classification of complex chronic disease (C-CD) compared to no chronic disease (N-CD) as neighborhood opportunity decreased or the disadvantage/deprivation/vulnerability increased. Being classified with a non-complex chronic disease (NC-CD) compared to N-CD, only the association with the COI increased incrementally at each level of opportunity. Study outcomes and index characteristics must be considered when designing studies.