278 - Pneumonia Prevention in Children with Neurologic Impairment: How Rurality and Social Determinants of Health Affect Care

Poster Number: 278
Publication Number: 278.81

Background: Children with neurological impairment (NI) face high risk of recurrent severe pneumonia, which may be exacerbated by the impact of social determinants of health (SDH) on receipt of expert-recommended pneumonia prevention strategies.

Objective: The purpose of this study was to evaluate the associations between rurality and other SDH on the receipt of pneumonia prevention strategies.

Design/Methods: Population: Patients aged ≤21 years with NI and ≥1 pneumonia hospitalization seen at Primary Children's Hospital between 6/1/08-5/31/23.

Primary Outcome: Receipt of pneumonia prevention strategy: routine dental care, gastric acid suppression, gastrostomy tube placement, chest physiotherapy, surrogate markers of a medical home (outpatient antibiotics before index hospitalization, clinic visit before or after index hospitalization), and flu vaccine.

Exposure variables: Rurality (Rural Urban Commuting Area codes), child opportunity index (COI) level (measures quality of resources and conditions that affect childhood health and wellbeing).

Analysis: Logistic regression model with propensity scored-based inverse probability treatment weighting. Model adjusted for sociodemographics, medical complexity, and characteristics of the index hospitalization.

Results: In n=3,395 children, 45% were female, 41% had public insurance, and 83% were White. The most common COI Levels were High (30%) and Moderate (28%). 13% lived in rural areas. Unadjusted analyses for rurality showed statistically significant differences across many variables, including clinic visit after discharge (p < 0.001) and clinic visit prior to admission (p=0.001); these were also significant for COI (p < 0.01 and p< 0.01, respectively). In adjusted models, rurality was associated with increased odds of clinic visit before admission (aOR of 1.83, 95% CI 1.16-2.88), and decreased odds of clinic visit after discharge (aOR of 0.29, 95% CI 0.18-0.45) and flu vaccine (aOR 0.53, 95% CI 0.31-0.90). COI level was associated with several variables, including decreased odds of clinic visit before hospitalization (aOR 0.69, 95% CI 0.63-0.74).

Conclusion(s): Rurality was associated with a seemingly paradoxical increased likelihood of clinic visit prior to hospitalization and a decreased likelihood of seasonal flu vaccine and post-discharge clinic visit; COI was associated with decreased likelihood of clinic visit prior to and after hospitalization. These differences may be attributed to a lack of a medical home in rural and underserved populations that is overcome only by the larger barrier of distance to accessing a hospital for care of pneumonia.