Greater Neighborhood Resources Predict Reduced In‐Hospital Death for Children With Heart Failure and Cardiomyopathy

Background Patients with pediatric heart failure (HF) face significant morbidity and death. However, there are limited data describing neighborhood characteristics in pediatric patients with HF or exploring the relationship of these factors to resource use and clinical outcomes. We used the Child Opportunity Index 3.0 (COI), a composite index of community resources pertinent to child health, to describe neighborhood characteristics for children with HF and identify its associations with in‐hospital death. Methods This retrospective cohort study used the Pediatric Health Information System, a national administrative database of tertiary care pediatric hospitals. Inpatient encounters between January 2014 and December 2024 for pediatric patients (aged <18 years) with HF and cardiomyopathy were identified using International Classification of Diseases ( ICD ) codes. The primary exposure of interest was the COI, and the primary outcome of interest was in‐hospital death. Mixed logistic regression models were estimated, unadjusted and adjusted for administrative sex, age, race, and primary payor. Results Our cohort consisted of index HF admissions in 7060 patients. Half of the cohort was in either the very low (n=2034 [29%]) or low (n=1521 [22%]) COI quintile. After adjustment, patients with a very high COI were less likely to experience in‐hospital death than those living in very low COI neighborhoods (odds ratio, 0.73 [95% CI, 0.54–0.99]; P =0.048). Conclusions A substantial proportion of children admitted with HF have limited neighborhood resources. Those with higher neighborhood resources are more likely to survive to discharge, emphasizing the relationship between environmental factors and clinical outcomes in pediatric HF.