How Neighborhood Sways Pediatric Primary and Preventive Care Access

Kids from traditionally underserved communities tend to have lower pediatric primary and preventive care access rates than their peers from more affluent places, a new JAMA Network Open study showed. This underscores the role neighborhood plays in health outcomes, researchers said.

The study, conducted by researchers at the Children’s Hospital of Philadelphia (CHOP), looked at the Childhood Opportunity Index (COI), which measures how neighborhood conditions and resources can influence healthy childhood development. The team said that the COI is an effective tool against which to measure pediatric health outcomes because it incorporates elements that affect childhood development.

And ultimately, the COI proved effective for predicting pediatric primary and preventive care access, plus other domains of childhood health.

Of the more than 338,000 kids ages 0 to 19 included in the analysis, around a quarter lived in neighborhoods with very low COI scores (meaning they were very disadvantaged), and more than a third lived in neighborhoods with very high COI scores.

The kids who lived in places with very high COI scores were more likely to be up-to-date on preventive visits and immunizations, indicating better access to pediatric primary care and the preventive services that often come with it.

This finding was unsurprising, considering previous research showing higher rates of acute and emergency use among kids from lower COI neighborhoods. Because kids from disadvantaged neighborhoods are less likely to access primary and preventive care, they may be more likely to experience an acute care episode. They may also be more likely to access emergency care in a non-emergency situation.

Moreover, kids from affluent areas had better health outcomes. Kids from neighborhoods with very high COI scores had lower odds of obesity, adolescent depression and suicidality, and maternal depression and suicidality.

Notably, the researchers did not look into the reasons why COI is linked with pediatric primary and preventive care access. However, they did project that certain structural and SDOH barriers linked with low COI could be at play. These issues could range from poor access to transportation all the way up to distrust in medical establishments.

“Living in a disadvantaged neighborhood may increase families’ exposure to a range of stressors, such as poverty, racism, food insecurity, and reduced access to health care, leading to parental stress and negatively impacting mental health outcomes in children,” the researchers posited. “In contrast, greater neighborhood safety and amenities may foster resilience.”

Still, understanding the link between COI and access to pediatric primary and preventive healthcare can be helpful for even individual providers, the researchers said.

For one thing, identifying neighborhood disadvantage could prompt providers to discuss potential barriers or SDOH with families (although SDOH screening should also be standardized across a practice).

Looking at COI could also help pediatric organizations plan quality improvement initiatives. The researchers recommended organizations with larger populations from lower COI communities create triage pathways for acute complaints to same-day well-visits. Organizations might also plan vaccination drives, conduct more developmental screening, or bolster mental health screening at all touchpoints.

“By using the COI in the evaluation of quality improvement efforts, interventions, and innovations, health systems may customize care to promote overall child well-being and ensure equitable allocation of resources to support the health of children across all COI levels,” the researchers concluded. “In addition, the COI and its component domains provide a potential road map for identification of strategic community-based partnerships that build on community strengths to advance health equity.”