This article is more than 5 years old. Information may no longer be current.

Poverty, criminal justice involvement, biggest risk factors for emergency department use among youth

Living in poverty or involvement in the juvenile or criminal justice system were the social complexity risk factors that made children more likely to use EDs, according to findings published in Annals in Family Medicine.

“Screening for social determinants of health is challenging but critically important for optimizing child health outcomes,” Kimberly C. Arthur, MPH, of the Seattle Children’s Research Institute, and colleagues wrote. “We aimed to test the feasibility of using an integrated state agency administrative database to identify social complexity risk factors and examined their relationship to ED use.”

“The long-term impact of adverse childhood experiences and social determinants of health is so significant that it is essential not to miss opportunities to intervene to support families,” Arthur told Healio Family Medicine.

Researchers linked social and health services administrative data between 505,367 Medicaid enrollees younger than 18 years and their parents to determine social complexity risk factors that have an established or potential link with health care use that is less than ideal.

Arthur and colleagues found that in children aged younger than 5 years, poverty (incidence rate ratio = 1.25; 95% CI, 1.23-1.28) was the most likely social complexity risk factor to lead to ED use, followed by, in order, parent’s mental illness, limited English proficiency, parent’s criminal justice involvement, child abuse or neglect, homelessness, parent’s domestic violence involvement, and a parent’s death.

Researchers also found that in children aged 5 years to 17 years, the child’s involvement in the juvenile or criminal justice system (IRR = 1.4; 95% CI, 1.33-1.46) was the most likely social complexity risk factor to lead to ED use, followed by, in order, a child’s personal substance abuse, poverty, parent’s mental illness, child abuse or neglect, a child’s personal mental illness, homeless, limited English proficiency, a parent’s death, parent’s criminal justice involvement and a parent’s domestic violence involvement.

Arthur said the results show it is indeed feasible to use existing social and health services administrative data to determine which children have social risk factors for ED use.

“The next step is to explore the feasibility of collaboration between state agencies and primary care practices to share a flag or score that could prompt in-person screening to get a clearer picture of both risk factors and protective factors,” she said in an interview.

“There are many existing screening tools for adverse childhood experiences and social determinants of health for physicians to use if it is feasible to implement screening. However, considering that many of the risk factors in our study were related to the well-being of the parent and the entire family, making sure to inquire about the well-being of the parent and other family members at each visit would be a good place to start,” Arthur added. – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.