Geographic Patterns of Pediatric Health and Opportunity: An Analysis of Social Vulnerability, Community Context, and Health Outcomes in South Carolina

Abstract

Pediatric health outcomes are influenced not only by clinical factors but also by the social and environmental conditions in which children live, yet this relationship remains underexplored at the community level. This retrospective, ecological study integrated all-payer claims data (2022) for South Carolina (SC) children and adolescents (≤19 years) with county-level Social Vulnerability Index (SVI) and Child Opportunity Index (COI) data to identify geographic hotspots of pediatric health conditions and assess associations with community-level factors. This hotspot analysis examined clustering of asthma, vaccine-preventable illnesses, mental health disorders, and avoidable hospitalizations, with a multivariable regression model controlling for rurality. Among the 134,185 healthcare encounters across 46 counties, significant geographic clustering was identified, with hotspots concentrated in high-SVI counties along the southern interior corridor of SC. Counties in the highest vulnerability quartile demonstrated elevated rates of asthma, preventable hospitalizations, and injury/trauma. A spatial analysis identified 13 hotspot counties, which were predominantly rural with small pediatric populations. Counties with large pediatric populations and moderate prevalence rates contributed disproportionately to the overall prevalence despite not meeting hotspot criteria. Pediatric health outcomes in South Carolina are not randomly distributed across the state. They follow clear geographic patterns and are linked to social vulnerability and opportunity, underscoring the need for targeted, place-based interventions to advance health equity