{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T03:51:28Z","timestamp":1785037888627,"version":"3.55.0"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,5,1]],"date-time":"2024-05-01T00:00:00Z","timestamp":1714521600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Neighborhood contextual factors are associated with liver transplant outcomes. We analyzed associations between neighborhood\u2010level socioeconomic status and healthcare utilization for pediatric liver transplant recipients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We merged the Pediatric Health Information System and Scientific Registry of Transplant Recipients databases and included liver transplant recipients \u226421 years hospitalized between January 2004 and May 2022. Outcomes were annual inpatient bed\u2010days, risk of hospitalizations, and risk of liver biopsies. The primary exposure was zip code\u2010based neighborhood income at transplant. We applied causal inference for variable selection in multivariable analysis. We modeled annual inpatient bed\u2010days with mixed\u2010effect zero\u2010inflated Poisson regression, and rates of hospitalization and liver biopsy with a Cox\u2010type proportional rate model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 1006 participants from 29 institutions. Children from low\u2010income neighborhoods were more likely to be publicly insured (67% vs. 46%), Black (20% vs. 12%), Hispanic (30% vs. 17%), and have higher model for end\u2010stage liver disease\/pediatric end\u2010stage liver disease model scores at transplant (17 vs. 13) than the remaining cohort. We found no differences in inpatient bed\u2010days or rates of hospitalization across neighborhood groups. In univariable analysis, low\u2010income neighborhoods were associated with increased rates of liver biopsy (rate ratio [RR]: 1.57, 95% confidence interval [CI]: 1.04\u22122.34, <jats:italic>p<\/jats:italic>\u2009=\u20090.03). These findings persisted after adjusting for insurance, race, and ethnicity (RR: 1.86, 95% CI:\u00a01.23\u22122.83, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Children from low\u2010income neighborhoods undergo more liver biopsies than other children. These procedures are invasive and potentially preventable. In addition to improving outcomes, interventions to mitigate health inequities among liver transplant recipients may reduce resource utilization.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jpn3.12234","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T06:54:33Z","timestamp":1714632873000},"page":"100-109","source":"Crossref","is-referenced-by-count":5,"title":["The influence of neighborhood income on healthcare utilization in pediatric liver transplant"],"prefix":"10.1002","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8625-5837","authenticated-orcid":false,"given":"Susan A.","family":"Gutierrez","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sy Han","family":"Chiou","sequence":"additional","affiliation":[{"name":"Department of Surgery University of California, San Francisco San Francisco California USA"},{"name":"Department of Statistics and Data Science Southern Methodist University Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Rhee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer C.","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5565-6670","authenticated-orcid":false,"given":"Sharad I.","family":"Wadhwani","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California, San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,5]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16494"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2011.10.038"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000004556"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000003157"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15786"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2022.03.007"},{"key":"e_1_2_9_8_1","first-page":"994","article-title":"Federating clinical data from six pediatric hospitals: process and initial results from the PHIS+ consortium","volume":"2011","author":"Narus SP","year":"2011","journal-title":"AMIA. 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