730 - Housing Instability and Pediatric Ambulatory Care Sensitive Conditions: A National Multicenter Analysis

Publication Number: 730.5223

Emma M. Hartswick Finch, Boston Children's Hospital; Boston Medical Center, Cambridge, MA, United States; Benjamin VM. Bajaj, Massachusetts General Hospital, Durham, NC, United States; Alexandra Geanacopoulos, Boston Children's Hospital, Boston, MA, United States; Alon Peltz, Harvard Medical School, Boston, MA, United States; Arvin Garg, UMass Memorial Children's Medical Center, Worcester, MA, United States; Kevin Fiori, Albert Einstein College of Medicine, Bronx, NY, United States; Jonathan M. Gabbay, Albert Einstein College of Medicine, Bronx, NY, United States

Background: Pediatric ambulatory care sensitive conditions (ACSCs), such as asthma, epilepsy, and diabetes mellitus, are conditions in which consistent, high-quality ambulatory care can prevent hospitalizations for disease-related complications. ACSC hospitalizations are consequential to children and their families, and represent a substantial economic burden on healthcare systems. There is limited data on the association of individual health-related social needs, such as housing instability, and adverse outcomes for ACSC hospitalizations. Such data can lead to informed housing policy interventions for health systems.

Objective: We aimed to examine the association between housing instability and ACSC hospitalization outcomes, including intensive care requirement, length of stay, and readmissions.

Design/Methods: We conducted a retrospective multicenter cohort study using the Pediatric Health Information Database from January 1, 2018, to July 31, 2024. Our study population included those aged < 18 years who were admitted to pediatric tertiary hospitals for an ACSC. Outcomes included intensive care unit admission, total hospital length of stay in days, and readmission within 30 days. Our primary exposure was a co-existing diagnosis of housing instability. We conducted mixed-effects multivariable regression models to estimate the association of our exposure and outcomes.

Results: Our cohort consisted of 1,212,580 inpatient encounters across 47 hospitals, comprised of 934,359 unique patients. There were 2,469 encounters with a diagnosis of housing instability. In adjusted models, there were higher odds of ICU utilization (aOR: 1.46; 95% CI: 1.31, 1.62) and re-admissions within 30 days (aOR: 1.40; 95% CI: 1.17, 1.68) among patients with housing instability compared to those without. Patients with housing instability also had longer hospital length of stay compared to those without (adjusted mean change: 1.93; 95% CI: 1.73, 2.12).

Conclusion(s): Our study found adverse health outcomes for children hospitalized with ACSCs who have housing instability. Health systems should aim to improve identification of hospitalized children with housing instability and explore the mechanisms by which housing instability impacts outcomes for specific ACSCs. Future research is needed to understand the costs associated with adverse outcomes for ACSCs that are mediated by housing instability, which can inform health policy and targeted housing interventions for at-risk children.

Patient encounter characteristics stratified by presence of housing instability
Study population included those aged < 18 years who were admitted to pediatric tertiary hospitals for ACSC January 1, 2018, and July 31, 2024.

Mixed-effects multivariate regression models for outcomes