Citation

Rigdon J, Montez K, Palakshappa D, Brown C, Downs SM, Albertini LW, Taxter AJ. J. Pediatr. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Elsevier Publishing)

DOI

10.1016/j.jpeds.2022.06.004

PMID

35697140

Abstract

OBJECTIVE: To characterize the association of children's social risk factors with total number of emergency department (ED) visits or hospitalization and time to first subsequent ED or hospitalization. STUDY DESIGN: This was a retrospective cohort study from 2017 to 2021 of patients seen at the general pediatric clinic with >1 social risk factor screening documented per visit. Negative binomial or Poisson regression modeled ED utilization and hospitalizations, as a function of total number of risk factors or each unique risk factor. Time-varying Cox models evaluated differences between those who screened positive and negative, controlling for demographic and clinical covariates.

RESULTS: Overall, 4674 patients (mean age 6.6 years, 49% female, 64% Hispanic, 21% Black) were evaluated across 20927 visits. Children with risk factors had higher rates of ADHD, failure to gain weight, asthma, and prematurity compared with children with no risk (all p<0.01). Adjusted models show a positive association between increased total number of factors and ED utilization (IRR 1.18, 95% CI 1.12, 1.23) and hospitalizations (IRR 1.36, 95% CI 1.26, 1.47). There were no associations between positive screen and time to first ED visit (HR 0.95, 95% CI: 0.85, 1.06; p=0.36) or hospitalization (HR 1.15, 95% CI: 0.84, 1.59; p=0.40).

CONCLUSION: Social risk factors were associated with increased ED utilization and hospitalizations at the patient level but not significantly associated with time to subsequent acute care use. Future research should evaluate the effect of focused interventions on healthcare utilization, such as those addressing food insecurity and transportation challenges.

Language: en

Keywords

pediatric; food insecurity; health disparities; healthcare utilization; social determinants of health; social risk factors