448 - Neighborhood opportunity and well child visit attendance in early childhood

Poster Number: 448
Publication Number: 448.329

Background: Lower neighborhood opportunity (measured by the Child Opportunity Index [COI], a composite measure of 29 place-based factors) is associated with increased pediatric morbidity and healthcare utilization. The COI is less often examined for association with disparities in well child visit (WCV) attendance; this may provide important context for the observed associations between the COI and adverse pediatric health indicators.

Objective: To evaluate associations between the COI and WCV attendance in early childhood.

Design/Methods: Upstate KIDS is a prospective, population-based birth cohort from New York state. Nationally normed quintiles of census tract overall COI at birth were the exposure (very low, low, moderate, high, very high). The proportion of recommended WCVs attended from birth up to 36 months of age was the outcome (assessed at 4, 8, 12, 18, 24, 30, and 36 months[m]). WCV attendance at 0-12m and 0-6m, when frequent visits are recommended, were sub-analyzed. The child’s parent-reported age at each visit, and previously published age ranges for each WCV on the American Academy of Pediatrics’ schedule, were used to determine the proportion of recommended WCVs children attended. Children with missing data for >30% WCVs were excluded (n=845, 17%). One-way ANOVA and chi square tests compared data. Associations were analyzed with a general linear model adjusted for child race and ethnicity (proxy for potential family-level experienced racism), maternal and paternal education, plurality, fertility treatment, and insurance type.

Results: Among 3,783 children, 61% had very high or high COI (Table 1). The mean proportion of WCVs attended was 0.61 (SD 0.31; range 0-1) and demonstrated a stepwise increase as COI increased from very low (0.41 [SD 0.31]) to very high (0.68 [SD 0.27]) [Figure 1]. Compared to children experiencing very high COI, those experiencing very low (beta [β] -0.27, standard error [SE] 0.02), low (β -0.15, SE 0.02), moderate (β -0.09, SE 0.01), or high (β -0.05, SE 0.01) COI demonstrated significantly lower WCV attendance (Table 2; all p<.0001). These findings persisted only for children experiencing very low COI after adjusting for covariates (β -0.08, SE 0.02, p<.0001). Findings were similar in infancy at 6m and 12m.

Conclusion(s): In this prospective cohort, very low COI at birth was significantly associated with decreased WCV attendance up to 36 months of age. Future research can evaluate if WCV attendance moderates associations between the COI and indicators of increased morbidity and healthcare utilization in early childhood.