O3275: Which Neighborhood-Level Metric is Most Appropriate in Pediatric Orthopaedic Health Equity Research?

Background: Neighborhood conditions are associated with access to care and outcomes. The Child Opportunity Index (COI) and Area Deprivation Index (ADI) are commonly used in pediatric orthopaedic research, but without clear rationale as to why one is chosen over the other. Despite an increasing volume of health equity research, the most appropriate neighborhood-level measure for pediatric orthopaedic research remains unclear. The purpose of this study was to determine (1) how COI and ADI correlate with each other and (2) compare their associations with previously established disparities in the timing and pathology associated with pediatric anterior cruciate ligament reconstruction (ACLR).

Methods: This is a retrospective cohort study of patients aged 18 years or less who underwent primary ACLR between 2010 to 2022 at a single tertiary center. Those who had multiligament reconstruction, revision ACLR, or intentionally staged or delayed procedures were excluded. COI and ADI scores were assigned by address at time of surgery. Only national-level COI and ADI scores were utilized, since the ADI does not provide continuous data at the state and metropolitan levels. Outcomes of interest included time to surgery and intra-operative concomitant pathology. Pearson’s correlation coefficients (r) were calculated for comparison of continuous variables. Regression analyses, reported with odds ratio (OR) and 95% confidence interval (CI), assessed the association of COI or ADI with clinical outcomes while controlling for confounders.

Results: A total of 563 patients were included in the study. COI and ADI demonstrated moderate correlation with each other (r=-0.69, p< 0.001). After controlling for insurance and time to surgery, when appliable, COI score was significantly associated with time to ACLR (OR -0.56; 95% CI -1.02, -0.11; p=0.02), need for meniscectomy (OR 0.99; 95% CI 0.98, 0.99; p=0.04), and surgery beyond 60 days (OR 0.98; 95% CI 0.98, 0.99; p< 0.001), 90 days (OR 0.99; 95% CI 0.98, 0.99; p< 0.001), and 180 days (OR 0.99; 95% CI 0.98, 1.0; p=0.04) after injury. In similar multivariable models, ADI was significantly associated with surgery beyond 60 (OR 1.02; 95% CI 1.01, 1.03; p< 0.001) and 90 days (OR 1.02; 95% CI 1.01, 1.02; p< 0.001) after injury, but no other outcomes.

Conclusion: COI and ADI correlate moderately with each other. COI may be more appropriate for use in pediatric orthopaedic research, as it is more frequently associated with previously established clinical disparities. It also provides state- and metropolitan-level scores that the ADI does not. Further research is required to compare these metrics in other contexts.