173 - Longitudinal Cohort Study to Determine the Relationship between the Social Drivers of Health and time to Subsequent Acute Care Use

Poster Number: 173
Publication Number: 173.412

Deepak Palakshappa, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States; Joseph Rigdon, Wake Forest School of Medicine, Winston-Salem, NC, United States; Alysha Taxter, Nationwide Children's Hospital, Columbus, OH, United States; Callie L. Brown, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Stephen M. Downs, Wake Forest Baptist Health - Brenner Children's Hospital, Winston Salem, NC, United States; Laurie W. Albertini, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States; Kimberly Montez, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, WINSTON-SALEM, NC, United States

Background: Health systems are implementing programs to address the social drivers of health (SDoH) because of the belief that addressing SDoH in clinical settings will improve children’s health and reduce unnecessary care. Although there is strong evidence in adults that SDoH lead to increased acute care use, studies in children have been mixed and largely limited to cross-sectional analyses.

Objective: The objective of this study was to determine the association between the SDoH and time to first subsequent emergency department (ED) visit or hospitalization

Design/Methods: We conducted a longitudinal retrospective cohort study at one academic primary care clinic that serves a low-income, racial/ethnic minority population. As part of routine care, all patients who present for an in-person visit (well-child and acute) are screened for SDoH (see Table). We extracted electronic health record data for all children who were screened at least once between January 2017 and May 2021. We constructed Kaplan-Meier curves to determine the difference in the time, in days, to first ED visit or hospitalization between children who screened positive for at least one SDoH and children who screened negative for all SDoH. We used time-varying Cox proportional hazard regression models to evaluate differences between those who screened positive and those who screened negative controlling for demographic and clinical covariates.

Results: Of the 8590 children included, the majority were male (51.4%) and Hispanic (61.5%) with a mean age of 6.9 years (SD: 5.2). Thirty percent (Nf2643) screened positive for at least one SDoH. There were a total of 2955 ED visits during the study period with a median follow up time of 2.12 years (IQR: 0.75-3.64), and a total of 311 hospitalizations with a median follow up time of 3.54 years (IQR: 2.62-3.98). As shown in the figure, we did not find a significant difference in time to first ED visit or hospitalization between children who screened positive for at least one SDoH and children who screened negative. In multivariable models, we did not find significant differences between children who screened positive and children who screened negative for time to first ED visit (HR: 0.95, 95% CI: 0.15, 6.07; p=0.36) or hospitalization (HR: 1.15, 95% CI: 0.12, 10.8; p=0.40) (Table).Conclusion(s): In this primarily under-resourced population, we did not find a significant association between SDoH and time to subsequent acute care use. Further longitudinal studies are needed to understand the complex relationship between the SDoH and healthcare utilization in children.
Table: Multivariable analysis evaluating the association between the social drivers of health and time to subsequent emergency department visit or hospitalizationSDoH-Social driver of health

*Models controlling for age, sex, race/ethnicity, anxiety, depression, eczema, prematurity, obesity, attention hyperactivity disorder, failure to gain weight, hypertension, and asthma
Figure: Time to subsequent Acute Care Use