Abstract
BACKGROUND AND OBJECTIVES: Social determinants of health (SDOH) impact healthcare access and outcomes for children, including those with neuromuscular disorders (NMD). This study examines the extent to which the Area Deprivation Index (ADI) and Child Opportunity Index (COI) provide similar evaluations of SDOH in children with NMD. METHODS: 463 children with NMD <18 years treated at a tertiary children's hospital met inclusion criteria. COI, calculated using ZIP codes, includes education, health and environment, and social and economic domains. ADI, based on census block, measures income, education, employment, and housing quality. Lower COI and higher ADI are thought to represent more adverse SDOH. Analyses included Pearson's correlations, t-tests, ANOVAs, and multivariable regressions. RESULTS: ADI and COI were negatively correlated (r = -0.71, P < .001). Furthermore, similar correlations were observed across COI's three subdomains: education (r = -0.71), social and economic (r = -0.67), and health and environment (r = -0.68) (all P < .001). However, ADI scores varied greatly within each COI quintile. ADI was lower and COI was higher for patients with private versus public insurance (P < .001) and for White and Asian versus Black and Hispanic children (P < .001). While COI did not differ among diagnoses (P = .73), ADI was higher for children with myelomeningocele (P = .003) and cerebral palsy (P = .03) compared with those with Charcot-Marie-Tooth disease. Lastly, there was no difference in ADI (P = .44) or COI (P = .71) based on sex. CONCLUSIONS: While ADI and COI are related, they assess SDOH differently. Using multiple SDOH indices may better capture SDOH's impacts on healthcare access and outcomes. KEY CONCEPTS: (1)The health of children with neuromuscular conditions is affected by social determinants of health.(2)Lower levels of social determinants of health have been shown to delay access to care and negatively impact children's health.(3)The Area Deprivation Index and Child Opportunity Index are two indices often used to quantify social determinants of health and have not yet been directly compared to evaluate their congruence.(4)This study identifies and explores gaps between these two measurements so that clinicians and researchers can more accurately evaluate the impacts of social determinants of health on children's health. LEVELS OF EVIDENCE: Level III as this is a retrospective cohort study.