Neighborhood-Level Socioeconomic Disadvantage and Adverse Outcomes for Infants with Biliary Atresia in the United States.

OBJECTIVE

To examine the associations between Child Opportunity Index (COI) and time to surgery as well as postoperative health care utilization for infants with biliary atresia (BA) undergoing Kasai hepatoportoenterostomy (HPE) in the United States.

STUDY

DESIGN

We conducted a retrospective cohort study of all infants with BA who underwent HPE within the Pediatric Health Information System database between 2014 and 2024. Our primary exposure was the COI, a composite measure of socioeconomic status at the ZIP code level. Primary outcomes were age at HPE in days; post-HPE length of stay (LOS); and hospital revisits (inpatient, observation, and emergency department) within 2 years post-HPE. We modeled median age at HPE using quantile regression, postoperative LOS using negative binomial regression, and revisits using Anderson-Gill recurrent event models with robust standard errors. We compared unadjusted models, models adjusted for race and ethnicity, and models adjusted for race and ethnicity as well as insurance status.

RESULTS

Among 1182 infants at 48 hospitals, median COI was 43 (Q1-Q3 20, 69) and median age at HPE was 56 days (Q1-Q3 38, 70). After adjustment, infants in the 20% most disadvantaged neighborhoods (very low COI) underwent HPE 8 days later than very high COI infants (β = 8.00, 95% CI 2.00-11.00, P = .001). COI was not associated with postoperative LOS. Very low COI was associated with higher risk of all-cause readmission in the univariable model (HR 1.38, 95% CI 1.14-1.68, P = .001) but lost significance in the model adjusted for race and ethnicity as well as insurance status (HR 1.22, 0.98-1.51, P = .076).

CONCLUSIONS

Although infants with BA from the most socioeconomically disadvantaged neighborhoods undergo HPE at later ages, neighborhood-level socioeconomic status was not associated with postoperative LOS or readmissions. Targeted interventions using the COI could improve timely access to surgical care for this vulnerable population.