Assessing the Impact of Neighborhood and Built Environment on Pediatric Perioperative Care: A Systematic Review of the Literature

Abstract

Context: Neighborhood and built environment encompass one key area of the Social Determinants of Health (SDOH) and is frequently assessed using area-level indices.

Objective: We sought to systematically review the pediatric surgery literature for use of commonly applied area-level indices and to compare their utility for prediction of outcomes.

Data sources: A literature search was conducted using PubMed, Ovid MEDLINE, Ovid MEDLINE Epub Ahead of Print, PsycInfo, and an artificial intelligence search tool (1/2013-2/2023).

Study selection: Inclusion required pediatric surgical patients in the US, surgical intervention performed, and use of an area-level metric.

Data extraction: Extraction domains included study, patient, and procedure characteristics.

Results: Area Deprivation Index is the most consistent and commonly accepted index. It is also the most granular, as it uses Census Block Groups. Child Opportunity Index is less granular (Census Tract), but incorporates pediatric-specific predictors of risk. Results with Social Vulnerability Index, Neighborhood Deprivation Index, and Neighborhood Socioeconomic Status were less consistent.

Limitations: All studies were retrospective and quality varied from good to fair.

Conclusions: While each index has strengths and limitations, standardization on ideal metric(s) for the pediatric surgical population will help build the inferential power needed to move from understanding the role of SDOH to building meaningful interventions towards equity in care.

Type of study: Systematic Review.

Level of evidence: Level III.

Keywords: Area-level deprivation; Neighborhood and built environment; Pediatric surgery; Social determinants of health; Surgical outcomes.