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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
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Foundation Awardee
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 1

Category: Health Equity/Community Health

Poster Session 1

(217) Child Opportunity Index (COI) and Maternal-Newborn Outcomes: A Desirability of Outcome Ranking (DOOR) Analysis

Wednesday, February 11, 2026
10:30 AM - 12:00 PM  
Objective:
To evaluate the association between child opportunity index (COI) and maternal-newborn dyadic outcomes using the desirability of outcome ranking (DOOR) methodology. COI quantifies neighborhood-level resources and conditions that support child development. We assessed how birth outcomes, ranked from most to least desirable, differed based on census tract-linked COI.

Study Design:
This retrospective cross-sectional study included all deliveries eligible for the Joint Commission’s PC-06 quality metric (term newborns without preexisting conditions) at seven hospitals within a large New York health system from 2019-2024. Patient home addresses were matched to census tracts and linked to their corresponding COI scores. Patients with missing COI scores were excluded. Birth outcomes were classified using DOOR methodology into four groups based on delivery mode and maternal or neonatal complications: (1) uncomplicated vaginal delivery, (2) uncomplicated cesarean delivery, (3) vaginal delivery with complications, and (4) cesarean delivery with complications. Maternal complications were defined using CDC severe maternal morbidity indicators, and neonatal complications by PC-06 criteria. Multinomial logistic regression assessed associations between COI and birth outcomes, adjusting for relevant covariates. 

Results:
A total of 113,451 deliveries were included. Birth outcomes by COI group are shown in the Figure; regression results are in the Table. Compared to very high COI neighborhoods, high and moderate COI were associated with lower odds of uncomplicated cesarean delivery and higher odds of vaginal delivery with complications. Low and very low COI were associated with higher odds of vaginal delivery with complications. COI was not significantly associated with cesarean delivery with complications.

Conclusion:
Neighborhood COI is associated with the quality and desirability of birth outcomes, suggesting that community-level disparities impact perinatal care.