Children living in low-opportunity neighborhoods use EDs more frequently
Children who reside within low-opportunity neighborhoods are more likely to receive care from emergency departments or urgent care settings four or more times annually, according to findings published in Pediatrics.
“There is rapidly developing literature about how health care providers can screen for and help mitigate social barriers to health, and more of this evidence has come from pediatric settings than any other medical context,” Ellen Kersten, PhD, from the department of psychiatry at the University of California, San Francisco, told Infectious Diseases in Children. “Additionally, the AAP has published more policy statements and clinical guidelines about incorporating social determinants of health into clinical care than any other professional medical association.”
To examine whether the Child Opportunity Index, which measures neighborhood context, can assist in determining which areas use pediatric acute care more frequently and receive more diagnoses in these settings, the researchers conducted a cross-sectional study of children aged younger than 18 years residing in San Francisco. All children were seen in an ED, an urgent care or both settings within three health care systems between 2007 and 2011.
Kersten and colleagues then compared neighborhood opportunity and income with the neighborhoods’ locations using hot-spot analysis. The researchers also assessed independent relationships between neighborhood opportunity, the use of acute care at least four times annually and receiving a diagnosis in these settings once adjustments were made for neighborhood income and the age, sex, payer, health system, race and ethnicity of the child.
Of the 47,175 children included in the analysis, those who lived in neighborhoods that demonstrated the lowest opportunity were more likely to visit acute-care settings four or more times in a year when compared with children who lived in neighborhoods that had high levels of opportunity (OR = 1.33; 95% CI, 1.03-1.73).
Although a positive relationship has been noted between injury-related visits and neighborhoods with high opportunity, children who were residents of very low-opportunity neighborhoods were over two times more likely to visit these settings for an assault-related injury when compared with children residing in the highest-opportunity neighborhoods (OR = 2.12; 95% CI, 1.27-3.54). The researchers observed a negative association between neighborhood opportunity and respiratory conditions, asthma and ambulatory care-sensitive conditions.
“These findings can provide an impetus for health care systems and providers who treat children to think about how to collaborate with sectors and community organizations outside of the health care setting,” Kersten said. “Furthermore, this research can help to better understand and address child health disparities, which are unjust and preventable differences in health for particular population groups.”
“We need interventions directly in low-opportunity neighborhoods to make a dent in these disparities,” she added. “The necessary interventions will likely vary by neighborhood and should be guided by community input but could include investments in public schools and daycares, improving access to healthy food and parks, and expanding local hiring and housing assistance programs.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.