586 - Disparities in hospitalization rates by age for ambulatory care sensitive conditions among the New Jersey population in 2019

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 586
Publication Number: 586.319

Liliana M. Cruz, K. Hovnanian Children's Hospital at Jersey Shore University Medical Center, BRADLEY BEACH, NJ, United States; Matt Hall, Children's Hospital Association, Lenexa, KS, United States; Jessica Bettenhausen, Children's Mercy Kansas City, Kansas City, MO, United States; Simon Gelman, Hackensack Meridian Health, Hackensack, NJ, United States; Jamie M. Pinto, K. Hovnanian Children's Hospital at Jersey Shore University Medical Center, Neptune, NJ, United States

Presenting Author(s)

Liliana M. Cruz, MD (she/her/hers)

Pediatric Hospital Medicine Fellow
K. Hovnanian Children's Hospital at Jersey Shore University Medical Center
BRADLEY BEACH, New Jersey, United States

Background: Ambulatory care-sensitive conditions (ACSCs) are conditions for which high-quality outpatient care can potentially prevent the need for hospitalization. Studies have consistently demonstrated a link between increased hospitalization rates due to ACSC and minority or low socioeconomic status. Neighborhood-level opportunities, described by the Child Opportunity Index (COI), have been previously used to explore the association of ACSC and other social determinants of health in the pediatric population, but have not explored the associations in pediatric and adult populations.

Objective: To determine the association between hospitalization rates for ACSC and neighborhood-based conditions utilizing the COI by age groups (0-17,18-24, 25-64, and 65 and above).

Design/Methods: Retrospective database analysis of the New Jersey (NJ) population during 2019. The exposure was the ZIP code-level COI, and the outcome was the hospitalization rate per 10,000 residents for ACSC. The COI uses 29 weighted indicators across three domains to describe the level of opportunity within a tract, from very low to very high. Demographics for the study population were established using census data from the American Community Survey. Hospitalizations for ACSC were extracted from the New Jersey state Inpatient Database (SID). We used Poisson regression models to compare hospitalization rates for ACSC across levels of COI.

Results: 7,349,317 people were included, the majority of which were white (53%). 29% of people living in very low COI areas were Black, and 39% were Hispanic, compared to 15% who were White. The rate of hospitalization by each ACSC diagnosis varied by age (Table). The three most common ACSC for children (0-17) were asthma, seizure, and bacterial pneumonia; for young adults (18-24) were seizure, diabetes, and depression. In adults (25-64) were diabetes, cellulitis, and chronic obstructive pulmonary disease (COPD); for the elderly group (65 years old and above) were cardiac heart failure, COPD, and bacterial pneumonia. We observed higher hospitalization rates for ACSC in the 0-17 (0.71 95% Confidence Interval [CI] 0.69-0.74), 18-24 (0.57 95%CI 0.54-0.61) and 25-64 (1.11 95%CI 1.09-1.13) age groups living in neighborhoods of very low COI (p< .001) (Figure). ACSC hospitalization rates decreased as COI tract increased across all age groups (p< .001).

Conclusion(s): Hospitalization rates for ACSC in NJ were associated with COI, suggesting that inequities are closely tied to health outcomes regardless of age. Findings support the use of COI to provide targeted interventions to reduce the rate of ACSC hospitalizations.