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Distribution of Emergency Department Encounters and Subsequent Hospital Admissions for Children by Child Opportunity Index

  • Sriram Ramgopal
    Correspondence
    Correspondence to: Sriram Ramgopal, MD, Division of Pediatric Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Box 62, Chicago, IL 60611, Phone: (312) 227-8237, Fax: (312) 227-9475
    Affiliations
    Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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  • Megan Attridge
    Affiliations
    Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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  • Manzilat Akande
    Affiliations
    Division of Pediatric Critical Care, Oklahoma University Health Sciences Center, Oklahoma, OK, United States
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  • Denise M. Goodman
    Affiliations
    Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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  • Julia A. Heneghan
    Affiliations
    Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital; University of Minnesota, Minneapolis, Minnesota, United States of America
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  • Michelle L. Macy
    Affiliations
    Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America

    Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago IL, USA
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      Abstract

      Objective

      To evaluate differences in emergency utilization (ED) utilization and subsequent admission among children by Child Opportunity Index (COI).

      Methods

      We performed a cross-sectional study of pediatric (<18 years) encounters to 194 EDs in Illinois from 2016-2020. Each encounter was assigned the postal code-level category from the COI 2.0. We described the difference in the percent of encounters between lower (Very Low and Low) and higher (Very High and High) COI overall and among diagnoses with overrepresentation from lower COI groups. We evaluated the association of diagnosis with COI in ordinal models adjusted for demographics.

      Results

      There were 4,653,026 eligible ED encounters classified by COI as Very Low (28.6%), Low (24.8%), Moderate (20.3%), High (15.6%), and Very High (10.8%) (difference between low and high COI encounters 27.0%). Diagnoses with the greatest difference between low and high COI were eye infection, upper respiratory tract infections, and cough. The COI distribution for children admitted from the ED (n=140,298) was 29.1% Very Low, 19.3% Low, 18.2% Moderate, 17.7% High, and 15.7% Very High (percent difference 15.1%). Diagnoses with the greatest differences between low and high COI among admitted patients were sickle cell crisis, asthma, and influenza. All ED diagnoses and 8/12 admission diagnoses were associated with lower COI in multivariable ordinal models.

      Conclusions

      Children from lower COI areas are overrepresented in ED and inpatient encounters overall and within certain diagnosis groups. Further research is required to examine how health outcomes may be influenced by the structural and contextual characteristics of a child's neighborhood.

      What's new

      Among children presenting to the emergency department and those subsequently admitted to the hospital, a disproportionate number live in areas with lower neighborhood opportunity. This finding was particularly notable among common diagnoses, including asthma, sickle cell disease, and influenza.

      Keywords

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