The availability of millions of patient records contained in different healthcare data sources such as claims, EMR (electronic medical records), self-reported surveys, along with consumer data on social determinants has made it possible to reveal interesting insights and predict future outcomes/strategies.  In this blog series, we will provide some of these findings.

In part 1 of this series, we presented some interesting insights regarding social determinants (income) and its impact on health.  We also revealed some insights on quality scores and why higher scores do not necessarily translate to cost savings.  Finally, we examined the relationship between care gaps and cost.  In particular, are there some care gaps that are more important to close than others?

In this installment, we will continue to reveal interesting observations, but this time, we focus on pediatric health.  Our findings have been gleaned through several large studies where we analyzed pediatric data across multiple care settings in different geographies.

Urban vs. Rural

Did you know that similar to what we see in adults, there is a relationship between income levels and health in the pediatric populations?  Several publications (Pampel, Denney & Krueger, 2012) had previously observed that in high-income countries, those with higher social status were less likely to be obese.  At face value, this seems both likely and unlikely.  While it is true that individuals with higher status may respond with healthy eating and regular exercise, it is equally true that kids from lower economic strata are likely to be malnourished and therefore less likely to be obese.  So, which is true?

Well, it turns out that in large metropolitan areas, there is an interesting divide that is formed based on urban settings and rural settings.  As we start moving to the rural outskirts of a large metropolitan area, we start observing interesting trends.  We see a statistically significant increase in obesity rates in low-income rural zip codes than in high-income urban zip codes. This increase in obesity is also manifested in an increase in juvenile diabetes.  Most likely, this is a result of unhealthy eating.  But it doesn’t end there.  We also see a prevalence of developmental disorders, autism, epilepsy and cerebral palsy in urban zip codes, whereas we see a higher incidence of asthma in rural settings.

Could there be an explanation for the higher incidence of developmental and genetic disorders amongst the pediatric populations in urban areas? While no conclusive evidence exists, the prevailing theory is that urban dwellers tend to marry late, and have children later in life, thus increasing the risk of pregnancy.  Another theory is that higher income residents of urban areas tend to be more pro-active in getting a developmental disorder diagnosis as compared to rural folks.  The higher rates of Asthma and Diabetes in rural settings could be explained on the basis of poor eating habits and non-adherence to Asthma inhaler medications, which in turn are correlated to poor social determinants.


What about age? Does age play a role in determining costs? It turns out that it does. As children age from infants to toddlers to pre-teens, their HHS-HCC risk decreases.  So, do their hospital admission rates and average costs.  There is another very interesting finding: mental/behavioral conditions are not in the top 5 diagnoses in in infants and toddlers.  However, in age group 5-10, they move up, and by the time kids hit 11-15, mental and behavioral health conditions are the top 3 most prevalent diagnoses.  This is accompanied by a higher incidence of Asthma in this higher age bracket.  This finding is also corroborated with publications (Katon et al, 2007) which concluded that “Youth with asthma have an almost twofold higher prevalence of comorbid anxiety and depressive disorder”.

Mental Health

Is there a relationship between Mental Health conditions (including Alcohol and Drug abuse) and the rural vs. urban divide?  Our studies have shown that the incidence of mental health conditions is negatively correlated with income and education levels.  As income and education levels decrease, the incidence of mental health increases.  This is consistent with the WHO study and findings on Social Determinants of Mental Health (find that here).  This international study concluded that poor mental health at an early age is linked to negative stressful experiences, many of which are induced through life choices determined by low income and education.  This is particularly devastating if these accumulate in early childhood.  Poor mental health drives low income and education which further deteriorates mental health, in a vicious downward spiral.

According to this WHO report, Parental mental health plays a key role in outcomes for children. For example, children of mothers with mental ill-health are five times more likely to have mental disorders. Poverty, and particularly debt, can increase maternal stress. Moreover, conflict between parents also carries risks for children. Exposure to multiple risks is particularly damaging as effects accumulate.

The Triple P-Positive Parenting Program recommended by WHO is a behavioral family intervention that aims to improve child behavior and development by altering the family environment to one that enables the child to realize its potential; thus, increasing the child’s life chances and reduc­ing the risks associated with poor mental health.

Are pediatric population health programs reflecting these findings?

 With all this data, should we assume that most large pediatric providers are focusing on the right population health programs?  Not quite.  We observed that most population health programs were still centered around Pediatric Diabetes and Asthma.  Our analysis showed that Epilepsy and Behavioral/Mental health conditions had a much bigger impact on cost.  However, we saw few pro-active programs focused on mental health and epilepsy.

We also determined that there is a large, untapped opportunity associated with preventable ER visits.  Roughly 50% of all ER visits (especially in winter months) were associated with cold, cough and fever in the infant age group.  Managed Medicaid and CHIPS have the highest number of fast track ER visits.

So, what are our top predictions for the future of pediatric population health? 

  1. Mental health and developmental disorders will continue to drive up costs, and there will be targeted population health programs based on social determinants of health
  2. Urban and rural settings will play an important role in determining the appropriate interventions
  3. Fast-tracking avoidable ER visits represents a big untapped opportunity for cost savings

If you’re ready to take a deeper look at your own pediatric population for 2019, contact us now for a discounted State of Pediatric Population Health Analysis! Shoot us an email at

Predictonomics Part 2: Children’s Health

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