O2154: Rates of Hirschsprung-associated Enterocolitis Decrease with Increasing Child Opportunity Index

Background: Hirschsprung-associated enterocolitis (HAEC) is the most common cause of morbidity and mortality in patients with Hirschsprung disease (HD). An association has been previously demonstrated between social determinants of health (SDOH) and HAEC using locally collected survey data elements. The Child Opportunity Index (COI) is a publicly available SDOH dataset that stratifies patients by address on a variety of indicators over three domains: education, health and environment, and social and economic. We aimed to understand if a relationship exists between COI scores and HAEC.

Methods: A single-institution, IRB-approved, retrospective review was performed. Home addresses were used to obtain census tract information that was combined with publicly available datasets to obtain numerical COI scores. The COI scores were stratified into categories (very low, low, medium, high, and very high) per the dataset’s specifications, and were compared by domain (education, health/environment, social/economic, overall). Comparisons between the HAEC and non-HAEC groups’ raw scores were performed using Mood’s median tests, and trend between categories was analyzed using the Cochran-Armitage test.

Results: The cohort comprised a total of 100 patients, of which 93 had available COI information. Of these, there were 27 patients (29.0%) who developed HAEC. There were no differences in sex, race/ethnicity, English-speaking status, or whether patients lived in state or out of state. There were no differences in clinical factors, including age at pull-through, operative approach, length of aganglionic colon, and trisomy 21 diagnosis. As child opportunity score increased from very low to very high, there was a statistically significant decrease in the incidence of HAEC (p=0.04) (Figure 1).

Conclusion: Using publicly available COI data, we demonstrated a significant association between increasing opportunity index and decreasing incidence of HAEC. This suggests an opportunity for targeted intervention in populations with low COI scores. Further prospective work may help to address inequities experienced by those in low opportunity regions.