Geospatial Hotspots of Pediatric LRTI Acute Care Reflect Differences in Neighborhood Opportunity

Introduction: Neighborhood-level social determinants of health can impact pediatric acute care (AC) utilization. Their role in bronchiolitis and other lower respiratory tract infections (LRTIs), the leading cause of pediatric hospitalization, is understudied. We evaluated geospatial hotspots of pediatric LRTI and hypothesized they would cluster in census tracts with lower Child Opportunity Index 3.0 (COI) scores and have higher ICU admission rates.


Methods: This retrospective, single-center study evaluated children < 2 years old receiving AC for LRTI from 2018-2023 in Franklin County, Ohio. Patient addresses were assigned to census tracts and linked to COI. Kulldorff’s spatial scan statistic was used to identify tracts with significantly elevated AC utilization rates, and sociodemographic variables were compared between patients within and outside of hotspots.


Results: Among 29,938 patients, 11% required ICU care, and 30% were hospitalized. We identified a 39-tract hotspot with a collective standardized incidence ratio of 2.1 (95% CI: 1.9-2.3) compared to the overall AC rate in Franklin County. Patients were stratified by COI quintiles and hotspot residence. Children living within the LRTI hotspot were more likely to live in areas of very low opportunity compared to children outside of hotspots (85% vs. 25%, p< 0.001). Those from the AC hotspot were more likely Black (50% vs 25%), publicly insured (85% vs 65%), and born prematurely (22% vs 16%) (all p< 0.001).

ICU patients were younger (6.3 vs 7.2 months), more frequently premature (25% vs 16%), and RSV+ (50% vs 13%). Compared to non-hotspot ICU patients, hotspot ICU patients were more likely to be from lower COI (88% vs 54%; p< 0.05). While ICU patients had typical clinical risk factors, hotspot residence was not associated with clinical severity. Individual- and neighborhood-level social determinants were associated with residence within the hotspot, suggesting that structural opportunity, not illness severity, may drive geographic clustering.


Conclusions: These findings underscore the role of neighborhood opportunity in shaping AC utilization and highlight the need for equity-informed strategies to address upstream drivers of health. Addressing place-based structural disadvantage may be essential to advancing equity in pediatric health.