Date of Award

Spring 3-27-2026

Embargo Period

12-31-2026

Document Type

Dissertation - MUSC Only

Degree Name

Doctor of Health Administration

Department

Health Administration

College

College of Health Professions

First Advisor

Kit Simpson

Second Advisor

Caitlin Koob

Third Advisor

Elizabeth Crabtree Killen

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.

Rights

Copyright is held by the author. All rights reserved.

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Available for download on Thursday, December 31, 2026

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