Geospatial Links Between Pediatric LRTI Acute Care Use and the Child Opportunity Index

BACKGROUND AND OBJECTIVES: Neighborhood social determinants influence pediatric acute care (AC) use, but their role in lower respiratory tract infections (LRTIs), the leading cause of pediatric hospitalization, is unclear. We mapped LRTI AC utilization and examined whether census tract-level Child Opportunity Index (COI) 3.0 scores were associated with LRTI hotspots, overall AC use, and pediatric intensive care unit (PICU) admission. METHODS: In this retrospective single-center study, we identified children younger than 2 years receiving AC for LRTI from 2018 to 2023 in Franklin County, Ohio, and neighboring counties. Patient addresses were geocoded and linked to COI by census tract. Kulldorff's spatial scan statistic was used to identify the most likely cluster of tracts with significantly elevated AC utilization. Sociodemographic characteristics were compared between patients residing in hotspot and non-hotspot tracts. RESULTS: We had 18 219 children contributing 22 977 AC encounters; 8.4% required PICU care. COI was negatively associated with LRTI AC utilization rates (R2 = 0.094; F1,477 = 49.48; P < .001). Lower-opportunity census tracts had higher LRTI AC and ICU-level encounter rates in tract-level negative binomial models; the social/economic and education domains showed the strongest associations. Patients in the primary LRTI hotspot were more likely to be Black, publicly insured, born prematurely, and residing in lower-opportunity neighborhoods. Hotspot tract residence was not associated with clinical severity, suggesting geographic clustering reflects structural disadvantages. CONCLUSIONS: Neighborhood opportunity was strongly associated with LRTI AC-use clustering. Equity-informed, place-based strategies that address structural drivers of health may reduce disparities in pediatric LRTI care.