Abstract
Objective
: To determine the prevalence of unmet social needs (USN) in a pediatric emergency
department (PED) patient population and examine disparities in USN by self-selected
language and patient demographics.
Methods
: We surveyed a convenience sample of English- and Spanish-speaking caregivers of
patients <18-years-old presenting to a free-standing children's hospital in Salt Lake
City, Utah. In the caregiver's self-selected language, the pediatric version of the
Screener for Intensifying Community Referrals for Health (p-SINCERE) assessed patient
demographics and 10 areas of social needs. The primary outcome was presence of USN.
Descriptive statistics compared 1) self-selected languages and 2) absence vs presence
of USN. Patient and caregiver-level risk factors associated with USN were identified
using multivariable logistic regression.
Results
: Of the 10156 patients seen in our PED from 04/01/2021 to 08/03/2021, there were
9922 eligible, 5357 approached, and 3987 enrolled caregivers. Of the 3987 caregivers
enrolled, self-selected language was English for 3662(91.8%) and Spanish for 325(8.2%).
There were 1680 enrolled caregivers with ≥1 USN, representing 39.7% of English-speaking
and 70.2% of Spanish-speaking caregivers(p<0.001). The odds of having ≥1 USN was more
than 2 times higher in Spanish-speakers than in English-speakers after adjustment.
Conclusion
: Unmet social needs are common for families presenting for care to a PED, especially
among Spanish-speaking caregivers. Furthermore, this study demonstrates disparities
in limited English proficiency (LEP), race/ethnicity, and child insurance status.
These findings support the practicality of utilizing the PED as an access point to
initiate social need screening and referrals to address SDOH and health disparities.
Keywords
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References
- Child Poverty Increased Nationally During COVID.Especially Among Latino and Black Children. 2021; (Accessed 09/05/2021)
- County-level demographic, social, economic, and lifestyle correlates of COVID-19 infection and death trajectories during the first wave of the pandemic in the United States.Sci Total Environ. Sep 10 2021; 786147495https://doi.org/10.1016/j.scitotenv.2021.147495
- Pandemic precarity: COVID-19 is exposing and exacerbating inequalities in the American heartland.Proc Natl Acad Sci U S A. Feb 23 2021; 118https://doi.org/10.1073/pnas.2020685118
Healthy People 2030. U.S. Department of Health and Human Services. 09/05/2021, 2021. Accessed 07/03/2021, 2021. https://health.gov/healthypeople/objectives-and-data/social-determinants-health
About Social Determinants of Health (SDOH). Centers for Disease Control and Prevention. 09/05/2021, 2021. Updated 2021-03-10T12:15:05Z. Accessed 09/05/2021, 2021. https://www.cdc.gov/socialdeterminants/about.html
- Unstable Housing and Caregiver and Child Health in Renter Families.Pediatrics. Feb 2018; 141https://doi.org/10.1542/peds.2017-2199
- Associations between housing instability and food insecurity with health care access in low-income children.Ambul Pediatr. 2008; 8 (Jan-Feb): 50-57https://doi.org/10.1016/j.ambp.2007.08.004
- Relationships Between Material Hardship, Resilience, and Health Care Use.Pediatrics. Feb 2020; 145https://doi.org/10.1542/peds.2019-1975
- Social Influences on Child Health.Pediatr Rev. 2021; vol. 7: 402-404
- Introduction of an Area Deprivation Index Measuring Patient Socioeconomic Status in an Integrated Health System: Implications for Population Health.EGEMS (Wash DC). 2016; 4: 1238https://doi.org/10.13063/2327-9214.1238
- Integrating Social Determinants of Health With Treatment and Prevention: A New Tool to Assess Local Area Deprivation.Prev Chronic Dis. Sep 15 2016; 13: E128https://doi.org/10.5888/pcd13.160221
- The social determinants of child health: variations across health outcomes - a population-based cross-sectional analysis.BMC Pediatr. Aug 17 2009; 9: 53https://doi.org/10.1186/1471-2431-9-53
- Where health disparities begin: the role of social and economic determinants–and why current policies may make matters worse.Health Aff (Millwood). Oct 2011; 30: 1852-1859https://doi.org/10.1377/hlthaff.2011.0685
- Implementing a Social Determinants Screening and Referral Infrastructure During Routine Emergency Department Visits, Utah, 2017-2018.Prev Chronic Dis. Jun 18 2020; 17: E45https://doi.org/10.5888/pcd17.190339
- Poverty and Child Health in the United States.Pediatrics. Apr 2016; 137https://doi.org/10.1542/peds.2016-0339
- Addressing social determinants of health at well child care visits: a cluster RCT.Pediatrics. Feb 2015; 135: e296-e304https://doi.org/10.1542/peds.2014-2888
- Pediatric Emergency Department Visits at US Children's Hospitals During the COVID-19 Pandemic.Pediatrics. Apr 2021; 147https://doi.org/10.1542/peds.2020-039628
- Characterizing pediatric emergency department visits during the COVID-19 pandemic.Am J Emerg Med. Mar 2021; 41: 201-204https://doi.org/10.1016/j.ajem.2020.11.037
- Disparities in Pediatric Emergency Department Length of Stay and Utilization Associated With Primary Language.Pediatr Emerg Care. Sep 24 2021; https://doi.org/10.1097/pec.0000000000002545
- Community Resource Needs Assessment Among Families Presenting to a Pediatric Emergency Department.Acad Pediatr. May-Jun 2019; 19: 378-385https://doi.org/10.1016/j.acap.2018.11.009
- Enforcement of the Emergency Medical Treatment and Labor Act, 2005 to 2014.Ann Emerg Med. Feb 2017; 69 (e1): 155-162https://doi.org/10.1016/j.annemergmed.2016.05.021
- Health care disparities in emergency medicine.Acad Emerg Med. Nov 2003; 10: 1176-1183https://doi.org/10.1111/j.1553-2712.2003.tb00600.x
- Food for Thought: A Randomized Trial of Food Insecurity Screening in the Emergency Department.Acad Pediatr. 08 2019; 19: 646-651https://doi.org/10.1016/j.acap.2018.11.014
- Social Emergency Medicine: Embracing the Dual Role of the Emergency Department in Acute Care and Population Health.Ann Emerg Med. Jul 2016; 68: 21-25https://doi.org/10.1016/j.annemergmed.2016.01.005
- Emergency department-based interventions affecting social determinants of health in the United States: A scoping review.Acad Emerg Med. Jun 2021; 28: 666-674https://doi.org/10.1111/acem.14201
- Child Health Disparities: What Can a Clinician Do?.Pediatrics. Nov 2015; 136: 961-968https://doi.org/10.1542/peds.2014-4126
- Envisioning a Better U.S. Health Care System for All: Reducing Barriers to Care and Addressing Social Determinants of Health.Ann Intern Med. Jan 21 2020; 172 (Suppl): S50-s59https://doi.org/10.7326/m19-2410
- Beyond health care: the role of social determinants in promoting health and health equity.Health. 2019; 20: 1-13
- Food Insecurity And Health Outcomes.Health Aff (Millwood). Nov 2015; 34: 1830-1839https://doi.org/10.1377/hlthaff.2015.0645
- Neighborhood Child Opportunity and Individual-Level Pediatric Acute Care Use and Diagnoses.Pediatrics. May 2018; 141https://doi.org/10.1542/peds.2017-2309
- Psychometric Evaluation of the Screener for Intensifying Community Referrals for Health.Eval Health Prof. Jul 8 2021; (1632787211029360)https://doi.org/10.1177/01632787211029360
- 2021
- A randomized trial on screening for social determinants of health: the iScreen study.Pediatrics. Dec 2014; 134: e1611-e1618https://doi.org/10.1542/peds.2014-1439
- Limited english proficiency, primary language at home, and disparities in children's health care: how language barriers are measured matters.Public Health Rep. Jul-Aug 2005; 120: 418-430https://doi.org/10.1177/003335490512000409
Health Coverage of Immigrants. Kaiser Family Foundation. Updated 2022-04-06. Accessed 04/15/2022, 2022. https://www.kff.org/racial-equity-and-health-policy/fact-sheet/health-coverage-of-immigrants/
Article Info
Publication History
Accepted:
May 1,
2022
Received:
February 1,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
Copyright © 2022 by Academic Pediatric Association
