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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Article Info
Publication History
Accepted:
June 5,
2022
Received:
April 12,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc. on behalf of Academic Pediatric Association
