BACKGROUND: The Childhood Opportunity Index (COI) is a multidimensional measure of neighborhood features associated with child health. Our objective was to determine if COI is associated with outcomes across the care continuum in children hospitalized for asthma. METHODS: This is a retrospective cohort study using the Pediatric Health Information System database of hospitalized children with asthma aged 2 to 18 years from May 1 2021 to April 30, 2022. Main exposure was COI. Outcomes were categorized into 3 periods: prehospitalization (illness severity), during hospitalization (length of stay [LOS] and cost), and posthospitalization (emergency department [ED] revisits and rehospitalizations within 365 days). Multivariable relationships between COI and outcomes were assessed with generalized estimating equations, adjusting for illness severity and age, sex, and clustering data by hospital. RESULTS: Of 19 119 asthma hospitalizations, 37.6% were for children with very low COI. Children with very low and low COI more often had critical or severe illness compared with children with high and very high COI (56.4% vs 47.5%, P <
.001). COI was not associated with adjusted LOS (P = .1) or cost (P = .1). Children with very low vs very high COI were more likely to revisit the ED (odds ratio [OR], 2.2
95% CI, 1.8-2.5) and be rehospitalized (OR, 1.8
95% CI, 1.6-2.1) within 365 days. CONCLUSION: Children with lower COI hospitalized for asthma were more often critically ill and experienced more ED revisits and rehospitalizations than children with higher COI but had similar adjusted LOS and cost. Evaluating outcomes across the care continuum, including before, during, and during hospitalization, rather than a single point in time may help identify disparities and develop targeted interventions.