114 - The Social Drivers of Health and Acute Healthcare Utilization Among a Pediatric Cohort

Poster Number: 114
Publication Number: 114.212

Kimberly Montez, 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; Deepak Palakshappa, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States

Background: The social drivers of health (SDoH) are largely responsible for child health inequities. Pediatric clinics are increasingly screening families for the SDoH. There are limited patient-level data from clinical settings on the association between SDoH and acute healthcare utilization.

Objective: The objective of this study was to characterize the association between SDoH and emergency room utilization and hospitalizations using patient-level data.

Design/Methods: Electronic health record data were extracted from one academic pediatric primary care clinic between January 2017 and May 2021 for children with at least 3 visits whose families had at least one documented response to an SDoH questionnaire: food insecurity, domestic violence, housing instability, transportation problems, legal issues, caregiving coping concerns or caregiver substance use concerns. Incidence rate ratios for emergency room utilization and hospitalizations for various SDoH were estimated using Poisson regression or negative binomial regression (as indicated by model goodness of fit tests) and were adjusted for age, sex, race, and ethnicity.

Results: Of the 4674 children screened, 48.6% were female; 63.7% identified as Hispanic, 21.4% as Black, 10.9% as other, and 4% as White. For the SDoH, 24.9% reported food insecurity, 1.3% domestic violence, 0.2% housing instability, 8.1% transportation problems, 0.1% legal problems, 3% caregiving coping concerns, and 19.1% caregiver substance use concerns (Table 1). All SDoH were significantly associated with emergency room utilization and hospitalizations in the unadjusted model, and only housing instability and caregiver substance use concerns were not significant in the adjusted model (Table 2). The incidence rate ratio estimate for the total number of SDoH (0-7) was 1.18 (95% CI: 1.13, 1.24; p < 0.001) for emergency room utilization and 1.44 (95% CI: 1.33, 1.56; p < 0.0001); for food insecurity, it was 1.20 (95% CI: 1.10, 1.31; p < 0.001) for emergency room utilization and 1.24 (95% CI: 1.03, 1.48, p=0.0214) for hospitalizations.Conclusion(s): In this cross-sectional study, we found a significant association between SDoH and acute healthcare utilization. The detrimental effects of SDoH could lead to poor child health and increased acute healthcare utilization. The increased cost of acute care use could lead families having unmet social needs. Further longitudinal studies are needed to better characterize this potential bidirectional relationship.
Table 1Key study variables during study follow up (ranges from 0.15-4.4 years, median 2.7 years) at the patient level
Table 2Incidence rate ratios for (i) emergency room utilization and (ii) hospitalizations for various social drivers of health. Incidence rate ratios estimated using Poisson regression or negative binomial regression, as indicated by deviance Chi-squared goodness of fit tests.