Neighborhood Opportunities Linked to Child Well-Being in Primary Care

Neighborhood conditions have long been recognized as influential factors affecting child health. A recent study yielded significant associations between neighborhood opportunity and pediatric primary care outcomes as measured by the Childhood Opportunity Index (COI), and various health metrics commonly observed in pediatric primary care.¹

The impact of neighborhood conditions on child health has been a subject of growing interest among investigators and healthcare professionals. However, prior studies have not explored the specific connection between the COI, a comprehensive measure of neighborhood environment, and pediatric primary care outcomes, according to the study.

The investigators of this cross-sectional study, led by Janani Ramachandran, MS, MPH, Clinical Futures and Policy Lab, Children’s Hospital of Philadelphia, aimed to evaluate the association between neighborhood opportunity, as indicated by the COI, and key health metrics frequently assessed in pediatric primary care settings. These metrics encompassed both access to preventive care and child well-being.

The primary outcomes consisted of several critical pediatric health indicators:

• Up-to-date preventive care and immunization status
• Presence of obesity
• Adolescent depression and suicidality
• Maternal depression and suicidality

Among the 338,277 patients included in the analysis, a noteworthy proportion resided in neighborhoods characterized by either very low (24.2%) or very high (38.5%) COI scores. The average age of the study population was 9.8 years, and 48.8% were female.

The results revealed living in neighborhoods with very high COI scores was linked with elevated odds of being up-to-date on preventive visits (odd's ratio [OR], 1.40; 95% CI, 1.32-1.48) and immunizations (OR, 1.77; 95% CI, 1.58-2.00) when compared with those living in neighborhoods with very low COI scores.

Investigators also identified an association between high COI neighborhoods and reduced likelihood of obesity (OR, 0.55; 95% CI, 0.52-0.58), adolescent depression (OR, 0.78; 95% CI, 0.72-0.84), adolescent suicidality (OR, 0.79; 95% CI, 0.73-0.85), maternal depression (OR, 0.78; 95% CI, 0.72-0.86), and maternal suicidality (OR, 0.71; 95% CI, 0.61-0.83).

“Our findings indicate that there are substantial differences in the percentage of children attending recommended preventive visits and receiving immunizations according to neighborhood opportunity, suggesting that many families in low opportunity neighborhoods must overcome substantial barriers to access preventive care,” the study stated.

This aligns with previous research that has identified spatial disparities related to neighborhood socioeconomic status, both in terms of the ratio of pediatric primary care practitioners to the pediatric population² and in the fulfillment of recommended preventive services, such as vaccinations and screenings³.

The findings emphasize the importance of improving access to preventive care in communities with lower COI scores and offer valuable insights for healthcare systems to identify areas that require additional support, investigators wrote. By understanding these associations, the team suggested collaboration of the health systems and community groups could effectively promote child well-being.¹

References

1. Ramachandran J, Mayne SL, Kelly MK, et al. Measures of neighborhood opportunity and adherence to recommended pediatric primary care. JAMA Netw Open. 2023;6(8):e2330784. doi:10.1001/jamanetworkopen.2023.30784

2. Mudd AE, Michael YL, Melly S, Moore K, Diez-Roux A, Forrest CB. Spatial accessibility to pediatric primary care in Philadelphia: an area-level cross sectional analysis. Int J Equity Health. 2019;18(1):76. doi:10.1186/s12939-019- 0962-x

3. Jones MN, Brown CM, Widener MJ, Sucharew HJ, Beck AF. Area-level socioeconomic factors are associated with noncompletion of pediatric preventive services. J Prim Care Community Health. 2016;7(3):143-148. doi:10. 1177/2150131916632361