P2.078: Where You Live Matters: Is County-Level Social Vulnerability Associated with Ambulatory Care-Sensitive Hospitalizations in Children?

Background: Ambulatory Care-Sensitive Hospitalizations (ACSHs) are hospital admissions for conditions like gastroenteritis (AGE), urinary tract infections (UTI), asthma, and diabetes (DM) that can be prevented through timely and effective outpatient care. High pediatric ACSH rates in a community may be an indicator of barriers to obtaining care, especially in socially vulnerable communities. The Social Vulnerability Index (SVI) [Figure 1] is a composite measure that ranks United States (US) counties based on social determinants of health to identify areas at higher risk of poor health outcomes. The relationship between county-level SVI and pediatric ACSHs remains unclear. We hypothesized that counties with higher SVI scores would have higher ACSH rates than those with lower SVI scores.

Methods: This retrospective cross-sectional study used publicly available, county-level risk-adjusted ACSH rates for AGE, UTI, asthma, and DM, along with three pediatric quality composite measures: overall (combined rates for asthma, DM, AGE, and UTI for 6-17 years), acute (combined AGE and UTI rates for 6-17 years), and chronic (combined asthma and DM rates for 6-17 years) from 2018-2020. The risk-adjusted rates are age, sex, and poverty adjusted, calculated per 100,000 county population, and were obtained from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUPnet) Database (https://www.ahrq.gov/data/hcup/index.html). Counties without ACSH data were excluded. We then matched the ACSH rates to the corresponding 2022 county-level SVI data from the Centers for Disease Control and Prevention Agency for Toxic Substances and Disease Registry (CDC/ATSDR). Counties were sorted into quartiles based on SVI score (Q1=least vulnerable; Q4=most vulnerable), with SVI ranges of 0-0.25 for Q1 and 0.75-1.00 for Q4. For each ACSH condition, the geometric mean, 95% confidence intervals (CIs), and rate differences (between SVI-Q4 and SVI-Q1) were calculated using the Statistical Package for the Social Sciences (SPSS) software version 26. A negative impact of higher SVI was defined by a higher ACSH rate in SVI-Q4 compared to SVI-Q1, with non-overlapping CIs indicating statistical significance.

Results: Pediatric ACSH data for 2,082 counties from 32 states, representing more than 70% of the US population, were included. Table 1 shows a stepwise increase in ACSH rates with increasing social vulnerability quartile across nearly all conditions and composite measures. Statistically significant differences were observed between the most and least vulnerable SVI quartiles for gastroenteritis, asthma, and all composite measures. No statistically significant difference was seen for UTI and DM.

Conclusion: High county-level social vulnerability is associated with increased rates of pediatric ACSHs, highlighting disparities in high-quality ambulatory care in the US. Our findings support the need for targeted and equitable interventions to reduce preventable pediatric hospitalizations among socially vulnerable communities.