Abstract
Objective
To evaluate differences in emergency department (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 to 2020. Each encounter was assigned to quntiles of COI 2.0
by postal code. 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 7/12
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.
Keywords
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Article Info
Publication History
Published online: June 09, 2022
Accepted:
June 5,
2022
Received:
April 12,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
Copyright © 2022 by Academic Pediatric Association
