Neighborhood child opportunity and its association with complicated inguinal hernia in children: an analysis of a national insurance claims-based database.

Background: The Child Opportunity Index (COI) is a measure of neighborhood conditions associated with healthy child development. Inguinal hernia repair (IHR) is a common pediatric procedure. We sought to evaluate the association between COI and complicated inguinal hernia (IH), incarcerated or strangulated IH, among children with employer-based insurance coverage.

Methods: We performed a retrospective cohort study of children who underwent IHR in the IBM Watson Health MarketScan^® Research Database from 2015 to 2019. Claims data were merged with the COI at the metropolitan statistical area (MSA) level. We performed a multivariate regression analysis to determine the association between COI and complicated IH.

Results: A total of 12,084 eligible pediatric patients were identified, of which 3.7%(n = 408) had IH. Children with complicated IH were younger than those with uncomplicated IH (2 vs. 3 years; p = 0.0016). There were no children from very low COI neighborhoods. There was no difference in COI between uncomplicated and complicated IH: (Low- 13.5% vs. 17.2%: Moderate- 67.3% vs. 63.5%; High- 19.2% vs. 19.4%; p = 0.19). Age (aOR: 0.967; 95% CI: 0.95-0.99), but not COI, was independently associated with decreased odds of complicated IH.

Conclusion: Neighborhood-level disadvantage, as measured by COI 2.0, was not an independent predictor of complicated IH among children with employer-based insurance coverage.

Level of evidence: II.