Research In Practice Blog

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How Does the Childhood Opportunity Index Relate to Pediatric Primary Care Outcomes?
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By Janani Ramachandran, M.S., M.P.H.

Intro 
The Childhood Opportunity Index (COI) is a tool that relatively weights 29 neighborhood attributes and synthesizes them into a measure that predicts health and economic outcomes. COI has been recognized as useful for estimating and predicting other health outcomes. Our clinical researchers noticed overlapping clinical measures and parallels to other COI associations, and they suspected that the COI might also be representative of pediatric primary care outcomes related to preventive care access and child well-being. 
 
Study design & findings 
In this study, a team of Clinical Futures researchers analyzed data from 338,227 pediatric patients with diverse demographics to understand how the Childhood Opportunity Index related to key pediatric primary care outcomes. They considered metrics pertaining to primary care, including recency of care, immunizations, obesity, depression, and suicidality.  
 
Children living in neighborhoods with high COI ratings were more likely to be up to date on preventive visits and immunizations and less likely to have obesity, depression, and suicidality. Maternal depression and suicidality were also measured; similarly, those with a high COI rating had lower odds of these well-being outcomes. Thus, the researchers demonstrated that neighborhood opportunity, as measured by the COI, indeed was associated with multiple pediatric primary care outcomes.  
 
Implications  
With the results of this study, pediatric primary care practitioners can now regard neighborhood opportunity as an indicator of risk and health status. These results also boost the COI’s usefulness as a tool for driving child well-being- and equity-focused public health programs, allowing for further targeting of locations and populations that need additional support.  

Clinical Futures author(s):  Janani Ramachandran, MS, MPH; Stephanie L. Mayne, PhD, MHS; Mary Kate Kelly, MPH; Maura Powell, MPH, MBA; George Dalembert, MD, MSHP; Brian Jenssen, MD, MSHP; and Alexander G. Fiks, MD, MSCE
 
Additional Children’s Hospital of Philadelphia authors: Katie E. McPeak, MD
 
Citation: 
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. Published 2023 Aug 1. doi:10.1001/jamanetworkopen.2023.30784