Rates of Hirschsprung-Associated Enterocolitis Decrease With Increasing Child Opportunity Index

Shruthi Srinivas; Katelyn Henderson; Kristine L Griffin; Elizabeth Thomas; Richard J Wood; Jacob C Langer; Ihab Halaweish

doi:10.1016/j.jpedsurg.2024.03.020

Rates of Hirschsprung-Associated Enterocolitis Decrease With Increasing Child Opportunity Index

J Pediatr Surg. 2024 Mar 14:S0022-3468(24)00171-4. doi: 10.1016/j.jpedsurg.2024.03.020. Online ahead of print.

Authors

Shruthi Srinivas¹, Katelyn Henderson², Kristine L Griffin¹, Elizabeth Thomas¹, Richard J Wood¹, Jacob C Langer³, Ihab Halaweish⁴

Affiliations

¹ Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
² The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH, 43210, USA.
³ Department of Surgery, Hospital for Sick Children at the University of Toronto, Toronto, Canada.
⁴ Department of Pediatric Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA. Electronic address: Ihab.Halaweish@NationwideChildrens.org.

PMID: 38584009
DOI: 10.1016/j.jpedsurg.2024.03.020

Abstract

Background: Hirschsprung-associated enterocolitis (HAEC) is the most common cause of morbidity and mortality in patients with Hirschsprung disease (HD). There is a correlation between social determinants of health (SDOH) and outcomes in children with HD. The Child Opportunity Index (COI) is a publicly available dataset that stratifies patients by address into levels of opportunity. We aimed to understand if a relationship exists between COI and HAEC.

Methods: A single-institution, IRB-approved, retrospective cohort study was performed of children with HD. Census tract information was used to obtain COI scores, which were stratified into categories (very low, low, medium, high, very high). Subgroups with and without history of HAEC were compared.

Results: The cohort had 100 patients, of which 93 had a COI score. There were 27 patients (29.0%) with HAEC. There were no differences in demographics or clinical factors, including length of aganglionic colon, operative approach, and age at pull-through. 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).

Conclusion: We demonstrate a significant association between increasing opportunity and decreasing incidence of HAEC. This suggests an opportunity for targeted intervention in populations with low opportunity.

Level of evidence: III.

Irb number: IRB14-00232.

Keywords: Colorectal surgery; Healthcare disparities; Pull-through; Social determinants of health; Socioeconomic disparities.