{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T06:51:01Z","timestamp":1791183061260,"version":"4.1.0"},"reference-count":43,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Social drivers of health (SDoH) are associated with pediatric hospital readmissions, but the contribution of neighborhood\u2010level measures remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Evaluate associations between neighborhood\u2010level SDoH, including the Child Opportunity Index (COI), Social Vulnerability Index (SVI), and Agency for Healthcare Research and Quality (AHRQ) SDoH variables, and pediatric readmission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>This single\u2010center retrospective study included 39,930 encounters of patients aged 1 month to 18 years from February 2019 through December 2023. Encounters were linked to census tract\u2010level SDoH data. Principal component analysis (PCA) was used to reduce AHRQ SDoH variables to 10 components. Logistic regression evaluated associations with 7\u2010day and 30\u2010day unplanned readmissions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median age at encounter was 6.7 years (interquartile range, 2.0\u201312.1 years); 54.7% of patients were Hispanic, and 62.5% had public insurance. Unplanned readmissions occurred in 3.8% of encounters within 7 days and 8.6% within 30 days. Neither COI nor SVI was associated with either readmission outcome in unadjusted or adjusted analyses (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u2009.05). PCA\u2010derived neighborhood constructs identified associations not captured by conventional indices. Military\u2010Associated Community Environment was independently associated with both 7\u2010day and 30\u2010day readmissions, and multiple neighborhood dimensions modified associations between clinical factors and readmission risk.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Conventional neighborhood\u2010level indices were not associated with pediatric readmission risk. However, PCA revealed multidimensional neighborhood characteristics associated with readmissions, primarily through interactions with specific clinical conditions. These findings suggest that neighborhood context influences pediatric readmission by modifying disease\u2010specific clinical vulnerability rather than through uniform effects across all patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhm.70504","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T05:54:27Z","timestamp":1791179667000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multidimensional neighborhood social drivers of health and pediatric hospital readmission risk"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7518-8747","authenticated-orcid":false,"given":"Britanny","family":"Winckler","sequence":"first","affiliation":[{"name":"Division of Hospital Medicine Rady Children's Health\u2014Orange County Orange California USA"},{"name":"Department of Pediatrics University of California, Irvine School of Medicine Irvine California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cadence","family":"Pinkerton","sequence":"additional","affiliation":[{"name":"Department of Statistics and Applied Probability University of California Santa Barbara California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Qu","sequence":"additional","affiliation":[{"name":"Department of Statistics and Applied Probability University of California Santa Barbara California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Ehwerhemuepha","sequence":"additional","affiliation":[{"name":"Department of Computational Research, Research Institute Rady Children's Health\u2014Orange County Orange California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"issue":"2","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1136\/jech.55.2.111","article-title":"Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review","volume":"55","author":"Pickett KE","year":"2001","journal-title":"J Epidemiol Community Health"},{"issue":"4","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2021-052592","article-title":"Neighborhood socioeconomic deprivation and health care utilization of medically complex children","volume":"149","author":"Thomson J","year":"2022","journal-title":"Pediatrics"},{"issue":"2","key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1002\/jhm.13252","article-title":"Association of neighborhood opportunity and pediatric hospitalization rates in the United States","volume":"19","author":"Carroll AR","year":"2024","journal-title":"J Hosp Med"},{"issue":"4","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.acap.2011.04.002","article-title":"Annual report on health care for children and youth in the United States: focus on trends in hospital use and quality","volume":"11","author":"Friedman B","year":"2011","journal-title":"Acad Pediatr"},{"issue":"8","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/j.acap.2018.06.006","article-title":"Annual report on health care for children and youth in the United States: focus on 30\u2010day unplanned inpatient readmissions, 2009 to 2014","volume":"18","author":"Heslin KC","year":"2018","journal-title":"Acad Pediatr"},{"issue":"2","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2018-1958","article-title":"Trends in pediatric hospitalizations and readmissions: 2010\u20132016","volume":"143","author":"Bucholz EM","year":"2019","journal-title":"Pediatrics"},{"issue":"2","key":"e_1_2_9_8_1","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2020-032755","article-title":"The Child Opportunity Index 2.0 and hospitalizations for ambulatory care sensitive conditions","volume":"148","author":"Krager MK","year":"2021","journal-title":"Pediatrics"},{"issue":"4","key":"e_1_2_9_9_1","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2017-2934","article-title":"Length of stay and cost of pediatric readmissions","volume":"141","author":"Markham JL","year":"2018","journal-title":"Pediatrics"},{"issue":"4","key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1001\/jama.2012.188351","article-title":"Pediatric readmission prevalence and variability across hospitals","volume":"309","author":"Berry JG","year":"2013","journal-title":"JAMA"},{"issue":"10","key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"e609","DOI":"10.1097\/PEC.0000000000001979","article-title":"Social risk screening in pediatric primary care anticipates acute care utilization","volume":"37","author":"Wurster Ovalle VM","year":"2021","journal-title":"Pediatr Emerg Care"},{"issue":"2","key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1080\/10903127.2018.1501124","article-title":"Emergency medical services utilization is associated with community deprivation in children","volume":"23","author":"Riney LC","year":"2019","journal-title":"Prehosp Emerg Care"},{"issue":"1","key":"e_1_2_9_13_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-020554","article-title":"Risk factors associated with paediatric unplanned hospital readmissions: a systematic review","volume":"9","author":"Zhou H","year":"2019","journal-title":"BMJ Open"},{"issue":"4","key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1002\/jhm.12810","article-title":"Child Opportunity Index 2.0 and acute care utilization among children with medical complexity","volume":"17","author":"Fritz CQ","year":"2022","journal-title":"J Hosp Med"},{"issue":"11","key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"645","DOI":"10.12788\/jhm.3396","article-title":"Effect of parental adverse childhood experiences and resilience on a child's healthcare reutilization","volume":"15","author":"Shah AN","year":"2020","journal-title":"J Hosp Med"},{"issue":"3","key":"e_1_2_9_16_1","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.annemergmed.2017.01.015","article-title":"Characteristics of pediatric emergency revisits after an asthma\u2010related hospitalization","volume":"70","author":"Johnson LH","year":"2017","journal-title":"Ann Emerg Med"},{"issue":"8","key":"e_1_2_9_17_1","doi-asserted-by":"crossref","first-page":"3473","DOI":"10.1210\/jc.2018-02232","article-title":"Association of area deprivation and diabetic ketoacidosis readmissions: comparative risk analysis of adults vs children with type 1 diabetes","volume":"104","author":"Everett E","year":"2019","journal-title":"J Clin Endocrinol Metab"},{"issue":"8","key":"e_1_2_9_18_1","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1542\/hpeds.2014-0184","article-title":"Clinical and geographic characterization of 30\u2010day readmissions in pediatric sickle cell crisis patients","volume":"5","author":"McMillan JE","year":"2015","journal-title":"Hosp Pediatr"},{"issue":"1","key":"e_1_2_9_19_1","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2022-060819","article-title":"Frequency of and risk factors associated with hospital readmission after sepsis","volume":"152","author":"Dashefsky HS","year":"2023","journal-title":"Pediatrics"},{"issue":"12","key":"e_1_2_9_20_1","doi-asserted-by":"crossref","first-page":"2308","DOI":"10.2105\/AJPH.2012.300806","article-title":"Geomedicine: area\u2010based socioeconomic measures for assessing risk of hospital reutilization among children admitted for asthma","volume":"102","author":"Beck AF","year":"2012","journal-title":"Am J Public Health"},{"issue":"5","key":"e_1_2_9_21_1","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1002\/jhm.13581","article-title":"Effect of neighborhood socioeconomic disadvantage on 30\u2010day readmissions: a systematic review","volume":"20","author":"Garrett L","year":"2025","journal-title":"J Hosp Med"},{"issue":"4","key":"e_1_2_9_22_1","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2024-067873","article-title":"The Child Opportunity Index and children's health: a meta\u2010analysis","volume":"155","author":"Tyris J","year":"2025","journal-title":"Pediatrics"},{"issue":"3","key":"e_1_2_9_23_1","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1377\/hlthaff.2021.00905","article-title":"Reductions in hospitalizations among children referred to a primary care\u2013based medical\u2010legal partnership","volume":"41","author":"Beck AF","year":"2022","journal-title":"Health Aff"},{"issue":"9","key":"e_1_2_9_24_1","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1377\/hlthaff.2018.05496","article-title":"Cooling the hot spots where child hospitalization rates are high: a neighborhood approach to population health","volume":"38","author":"Beck AF","year":"2019","journal-title":"Health Aff"},{"issue":"9","key":"e_1_2_9_25_1","doi-asserted-by":"crossref","DOI":"10.2196\/26231","article-title":"Understanding pediatric surgery cancellation: geospatial analysis","volume":"23","author":"Liu L","year":"2021","journal-title":"J Med Internet Res"},{"key":"e_1_2_9_26_1","unstructured":"CDC. SVI Data & Documentation Download. Place and Health\u2014Geospatial Research Analysis and Services Program (GRASP). May 12 2026. Accessed August 31 2026.https:\/\/www.atsdr.cdc.gov\/place-health\/php\/svi\/svi-data-documentation-download.html"},{"key":"e_1_2_9_27_1","unstructured":"Child Opportunity Index (COI). diversitydatakids.org. Accessed October 3 2023.https:\/\/www.diversitydatakids.org\/child-opportunity-index"},{"issue":"4","key":"e_1_2_9_28_1","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1016\/j.acap.2021.12.015","article-title":"The association of the Childhood Opportunity Index on pediatric readmissions and emergency department revisits","volume":"22","author":"Bettenhausen JL","year":"2022","journal-title":"Acad Pediatr"},{"issue":"11","key":"e_1_2_9_29_1","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1542\/hpeds.2023-007279","article-title":"Child Opportunity Index and rehospitalization for ambulatory care sensitive conditions at US children's hospitals","volume":"13","author":"Parikh K","year":"2023","journal-title":"Hosp Pediatr"},{"issue":"11","key":"e_1_2_9_30_1","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1177\/00099228251342401","article-title":"Postdischarge pediatric primary care \u201cconnectivity\u201d and 7\u2010day and 30\u2010day readmission rates","volume":"64","author":"Weiss MA","year":"2025","journal-title":"Clin Pediatr Phila"},{"issue":"1","key":"e_1_2_9_31_1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1542\/hpeds.2019-0122","article-title":"A statistical\u2010learning model for unplanned 7\u2010day readmission in pediatrics","volume":"10","author":"Ehwerhemuepha L","year":"2020","journal-title":"Hosp Pediatr"},{"issue":"10","key":"e_1_2_9_32_1","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1542\/hpeds.2020-005786","article-title":"Targeted clinical interventions for reducing pediatric readmissions","volume":"11","author":"Pugh K","year":"2021","journal-title":"Hosp Pediatr"},{"issue":"6","key":"e_1_2_9_33_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0235064","article-title":"Assessing the impact of social determinants of health on predictive models for potentially avoidable 30\u2010day readmission or death","volume":"15","author":"Zhang Y","year":"2020","journal-title":"PLoS One"},{"issue":"5","key":"e_1_2_9_34_1","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1111\/j.1475-6773.2005.00449.x","article-title":"Conceptualizing and categorizing race and ethnicity in health services research","volume":"40","author":"Ford ME","year":"2005","journal-title":"Health Serv Res"},{"issue":"5","key":"e_1_2_9_35_1","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1007\/S40037-020-00602-3","article-title":"Considerations for using race and ethnicity as quantitative variables in medical education research","volume":"9","author":"Ross PT","year":"2020","journal-title":"Perspect Med Educ"},{"key":"e_1_2_9_36_1","unstructured":"Social Determinants of Health Database (Beta Version). Accessed April 18 2025.https:\/\/www.ahrq.gov\/sdoh\/data-analytics\/sdoh-data.html"},{"issue":"4","key":"e_1_2_9_37_1","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1002\/wics.101","article-title":"Principal component analysis","volume":"2","author":"Abdi H","year":"2010","journal-title":"WIREs Comput Stat"},{"key":"e_1_2_9_38_1","article-title":"Social risk factors for pediatric asthma exacerbations: a systematic review","author":"Vinjimoor S","year":"2023","journal-title":"medRxiv"},{"issue":"1","key":"e_1_2_9_39_1","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1007\/s10143-025-03477-2","article-title":"Impact of social factors on outcomes following pediatric neuro\u2010oncology surgery in the United States: a systematic review and meta\u2010analysis","volume":"48","author":"Kumar N","year":"2025","journal-title":"Neurosurg Rev"},{"key":"e_1_2_9_40_1","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.jpeds.2021.08.078","article-title":"Association of race\/ethnicity and social determinants with rehospitalization for mental health conditions at acute care children's hospitals","volume":"240","author":"Carroll AR","year":"2022","journal-title":"J Pediatr"},{"issue":"5","key":"e_1_2_9_41_1","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1200\/OP.23.00810","article-title":"Social determinants of health and cancer care: an ASCO policy statement","volume":"20","author":"Tucker\u2010Seeley R","year":"2024","journal-title":"JCO Oncol Pract"},{"issue":"1","key":"e_1_2_9_42_1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s10995-021-03310-4","article-title":"Association between neighborhood disadvantage and pediatric readmissions","volume":"26","author":"Nacht CL","year":"2022","journal-title":"Matern Child Health J"},{"key":"e_1_2_9_43_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jpeds.2025.114626","article-title":"The Child Opportunity Index: advancing precision social medicine","volume":"283","author":"Gabbay JM","year":"2025","journal-title":"J Pediatr"},{"issue":"5","key":"e_1_2_9_44_1","doi-asserted-by":"crossref","first-page":"e1657","DOI":"10.7205\/MILMED-D-16-00191","article-title":"Examining associations between relocation, continuity of care, and patient satisfaction in military spouses","volume":"182","author":"Gleason JL","year":"2017","journal-title":"Mil Med"}],"container-title":["Journal of Hospital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jhm.70504","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jhm.70504","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jhm.70504","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T05:54:33Z","timestamp":1791179673000},"score":1,"resource":{"primary":{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/10.1002\/jhm.70504"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,4]]},"references-count":43,"alternative-id":["10.1002\/jhm.70504"],"URL":"https:\/\/doi.org\/10.1002\/jhm.70504","archive":["Portico"],"relation":{},"ISSN":["1553-5592","1553-5606"],"issn-type":[{"value":"1553-5592","type":"print"},{"value":"1553-5606","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,4]]},"assertion":[{"value":"2026-04-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jhm.70504"}}