Access to Preventive Care and Social Determinants of Child Obesity: A Retrospective Cohort Study Using the Pinc AI™ Healthcare Database (PHD)

OBJECTIVES: Child obesity can have a negative impact on a child’s development and well-being. Access to healthcare is an important protective factor against child obesity. We investigated access to preventive care and social vulnerability in pediatric patients with available diagnosis of healthy weight, overweight, and obesity using the PINC AI™ Healthcare Database (PHD).

METHODS: Study patients were 6 to 17 years old with a healthy weight (ICD-10-CM Z68.52), overweight (Z68.53), or obesity (Z68.54) diagnosis with a hospital encounter between 01/01/2016 and 12/31/2019 and with follow-up through 12/31/2022. County-level social vulnerability index (SVI) and visit rates for preventive care were evaluated using adjusted multinomial logistic regression and adjusted logistic regressions, respectively. Covariates included sex, age, race, and ethnicity.

RESULTS: Patients (N = 64,200) were categorized as healthy weight (24%), overweight (12%) and obese (64%). Patients were 13 years old on average (SD = 3.3), and were mostly female (53%), White (56%), and with an average follow-up of 23 months (SD = 23). Obese (vs. healthy weight) patients were more frequently admitted to small (34% vs. 21%), Southern (48% vs. 39%), and non-teaching hospitals (40% vs. 25%). Obese (vs. healthy weight) patients were more likely to have higher SVI (12% vs. 6.4% within the most vulnerable quintile, adjusted odds ratio [95% CI] = 1.32 [1.19 – 1.46], p < 0.001), and had fewer visits for routine encounters (4.4% vs. 14%, p < 0.001), immunizations (1.9% vs. 6.0%, p < 0.001), dietary counseling (2.5% vs. 5.1%, p < 0.001), and exercise counseling (0.6% vs. 3.6%, p < 0.001).

CONCLUSIONS: Pediatric patients diagnosed with obesity have higher social vulnerability and receive less preventive care. Childhood obesity is a major public health concern in the United States. Improving access to general preventive care and reducing social vulnerability in obese children is urgently warranted.