Association of Pediatric Mortality With the Child Opportunity Index Among Children Presenting to the Emergency Department

Megan M. Attridge, Julia A. Heneghan, Manzilat Akande, Sriram Ramgopal

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: Child health and development is influenced by neighborhood context. The Child Opportunity Index (COI) is a multidimensional measure of neighborhood conditions. We sought to evaluate the association of COI with mortality among children presenting to the emergency department (ED). Methods: We performed a multicenter cross-sectional study of pediatric (<18 years) ED encounters from a statewide dataset from 2016 to 2020. We constructed a multivariable logistic regression model to evaluate the association between COI and in-hospital mortality after adjusting for sociodemographic characteristics and medical complexity. Results: Among 4,653,070 included encounters, in-hospital mortality occurred in 1855 (0.04%). There was a higher proportion of encounters with mortality in the lower COI categories relative to the higher COI categories (0.053%, 0.038%, 0.031%, 0.034%, 0.034% ranging from Very Low to Very High, respectively). In adjusted models, child residence in Low (adjusted odds ratio 1.26; 95% confidence interval [CI], 1.04–1.53) and Very Low (adjusted odds ratio 1.58; 95% CI, 1.31–1.90) COI neighborhoods was associated with mortality relative to residence in Very High COI neighborhoods. This association was noted across all domains of COI (education, health and environment, and social and economic), using an expanded definition of mortality, using nationally normed COI, and excluding patients with complex chronic conditions. Other factors associated with increased odds of mortality included age, medical complexity, payor status, age, and race and ethnicity. Conclusions: Understanding the association of neighborhood context on child mortality can inform public health interventions to improve child mortality rates and reduce disparities.

Original languageEnglish (US)
Pages (from-to)980-987
Number of pages8
JournalAcademic Pediatrics
Issue number5
StatePublished - Jul 2023

Bibliographical note

Funding Information:
Financial statement: The authors have no financial relationships relevant to this article to disclose.

Publisher Copyright:
© 2023 Academic Pediatric Association


  • area deprivation
  • Child Opportunity Index
  • neighborhood opportunity
  • pediatric mortality
  • social determinants of health

PubMed: MeSH publication types

  • Multicenter Study
  • Journal Article


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