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

  • Sriram Ramgopal
    Correspondence
    Address 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
    Affiliations
    Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine (S Ramgopal, M Attridge, and ML Macy), Chicago, Ill
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  • Megan Attridge
    Affiliations
    Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine (S Ramgopal, M Attridge, and ML Macy), Chicago, Ill
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  • Manzilat Akande
    Affiliations
    Section of Critical Care, Oklahoma University Health Sciences Center (M Akande), Oklahoma, Okla
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  • Denise M. Goodman
    Affiliations
    Division of Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine (DM Goodman), Chicago, Ill
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  • Julia A. Heneghan
    Affiliations
    Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital; University of Minnesota (JA Heneghan), Minneapolis, Minn
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  • Michelle L. Macy
    Affiliations
    Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine (S Ramgopal, M Attridge, and ML Macy), Chicago, Ill

    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 (ML Macy), Chicago Ill
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      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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