Precision risk assessment for pediatric hospitalization using address-level data in Cincinnati, Ohio

Introduction: Persistent disparities in child health highlight the need for clinical and public health research approaches to identify and address risks with greater spatial precision. This study linked residence- and neighborhood-specific socio-environmental data to population-wide healthcare data to characterize pediatric hospitalization risk for every residential address in Cincinnati, Ohio. Methods: We linked hospitalization data (07/01/2016 - 06/30/2022) to parcel-level housing data from the Hamilton County Auditor and Cincinnati Department of Buildings & Inspections and street-range crime data from the Cincinnati Police Department. Addresses were localized to 2010 census tracts to join variables from the U.S. Census American Community Survey and Eviction Lab. Generalized random forest models estimated address-level hospitalization risk and birth-adjusted hospitalization risk, accounting for child residency using vital birth records. Model performance was assessed based on varying diagnostic thresholds; fairness was evaluated by census block-level racial demographics. Results: We matched 81.5% of hospitalizations to residential addresses. Among 77,077 addresses, 7.4% had [≥]1 hospitalization. Our model performed well (ROC-AUC: 0.98 - 0.99; PR-AUC: 0.65 - 0.72) in characterizing high-risk addresses, with housing violations, violent crime, and market total value among top features. The birth-adjusted model also showed high performance (ROC-AUC: 0.92 - 0.93; PR-AUC: 0.65 - 0.78) and moderate agreement with the hospitalization risk model ({kappa}=0.43). Conclusions: Our results highlight the potential of address-level modeling and multiscale data integration to build on traditional area-level analyses and advance precision population health. Future directions include geographic expansion, stakeholder engagement, and patient-level validation. This work offers a scalable approach to precisely identifying pediatric health risks, supporting targeted clinical and policy interventions.