The Child Opportunity Index as a Moderator of the Effectiveness of Multi-Modal Evidence-Based Asthma Care.

OBJECTIVE

To evaluate if the Child Opportunity Index (COI) moderates associations between receiving a multimodal evidence-based asthma intervention and asthma-related emergency department (ED) reutilization among children.

METHODS

We identified a prospective cohort of children ≤16 years old with ≥1 asthma-related ED visit(s) in 2022 from our city-wide asthma registry. We evaluated associations between receiving evidence-based asthma care through a locally validated intervention (exposure) and risk of ED reutilization within one year of the first ED visit (outcome) stratified by age (0-4, 5-11, 12-16 years), modeling recurrent events using survival analysis. We then tested for interactions between the COI and receiving the asthma intervention by stratifying by census tract COI 3.0 (moderator) which we dichotomized into lower (very low/low) and higher (moderate/high/very high) COI.

RESULTS

There were 4125 ED encounters among 2244 children. Most lived in lower COI areas (67.2%, n = 1507). Two-hundred and eighty children (12.5%) received the multimodal evidence-based asthma intervention, which overall was associated with a reduced risk of ED reutilization (adjusted hazard ratio [aHR] 0.58, 95%CI: 0.48, 0.71). Among children 5-11 years old, this reduction was significantly less in those from lower COI areas (aHR 0.64, 83.4%CI 0.52, 0.79) than in those from higher COI areas (aHR 0.21, 83.4%CI 0.12, 0.38) (p-interaction = 0.01). The COI did not moderate associations for other age groups.

CONCLUSIONS

Adjusting effective evidence-based asthma care interventions to enhance their impact for children experiencing COI-related barriers, while partnering with communities to eradicate the root causes of lower COI, may be needed to achieve more equitable outcomes.