Children's lower socioeconomic status associated with more emergency visits

Newton AS. CMAJ. 2012;doi:10.1503/cmaj.111697.

  • June 29, 2012

First Nations children — or indigenous peoples of Canada — and children whose families receive government assistance made more visits to the ED for mental health crises than children who did not receive government assistance, according to study results.

Amanda S. Newton, PhD, of the University of Alberta, and colleagues conducted a population-based cohort analysis of ED visits by 20,956 children aged younger than 18 years in Alberta from 2002 to 2008. The researchers identified children of families receiving no social assistance, children of First Nations treaty status, and welfare recipients or recipients of other government-sponsored programs through the Ambulatory Care Classification System.

Children included in the cohort study had a main ambulatory care diagnosis for mental illness, mental and behavioral disorders secondary to substance abuse, or intentional self-harm. Newton and colleagues calculated age-specific ED visits per 100,000 Alberta citizens for each sex, and they developed multivariable Cox proportional hazard models and a competing risk model to examine the time to return to the ED and follow-ups with physicians.

First Nations children aged 15 to 17 years had the highest rate of visits for girls (7,047 per 100,000 children) and boys (5,787 per 100,000 children). Children in the same age group whose families received no government subsidy had the lowest rates (girls: 2,155 per 100,000 children; boys: 1,323 per 100,000 children). First Nations children (HR=1.64; 95% CI, 1.30-2.05) and children whose families received government subsidies (HR=1.60; 95% CI, 1.30-1.98) had a higher risk of return to an ED for mental health care compared with other children. The longest median time to follow-up with a physician was among First Nations children (95% CI, 60-91 days). First Nation status, according to researchers, predicted a longer time to follow-up with a psychiatrist (HR=0.47; 95% CI, 0.32-0.70).

Results also showed that among children who had a follow-up visit, 70.2% were for mental health concerns and 53.2% were made to a psychiatrist.

“Visits to the emergency department for mental health care should be considered a ‘stop gap’ solution in the full suite of mental health services,” the researchers wrote. “For many children, these visits reflect a need for earlier intervention to prevent illness destabilization into crisis. Further, children with longer times to follow-up care in the post-crisis period may also be disadvantaged because they likely require continued support for stabilization. We found that sociodemographic status plays an important role in the post-crisis use of health care services.”

Disclosure: The researchers report no relevant financial disclosures.

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