Social Risk Factors Influence Pediatric Emergency Department Utilization and Hospitalizations

J Pediatr. 2022 Oct:249:35-42.e4. doi: 10.1016/j.jpeds.2022.06.004. Epub 2022 Jun 10.


Objective: To characterize the association of children's social risk factors with total number of emergency department (ED) visits or hospitalization and time to first subsequent ED or hospitalization.

Study design: This was a retrospective cohort study of patients seen at a general pediatric clinic between 2017 and 2021 with documented ≥1 social risk factors screened per visit. Negative binomial or Poisson regression modeled ED utilization and hospitalizations as functions of the total number of risk factors or each unique risk factor. Time-varying Cox models were used to evaluate differences between those who screened positive and those who screened negative, controlling for demographic and clinical covariates.

Results: Overall, 4674 patients (mean age, 6.6 years; 49% female; 64% Hispanic; 21% Black) were evaluated across a total of 20 927 visits. Children with risk factors had higher rates of attention-deficit hyperactivity disorder, failure to gain weight, asthma, and prematurity compared with children with no risk (all P < .01). Adjusted models show a positive association between increased total number of factors and ED utilization (incidence rate ratio [IRR], 1.18; 95% CI, 1.12-1.23) and hospitalizations (IRR, 1.36; 95% CI, 1.26-1.47). There were no associations between a positive screen and time to first ED visit (hazard ratio [HR], 0.95; 95% CI, 0.85-1.06; P = .36) or hospitalization (HR, 1.15; 95% CI, 0.84-1.59; P = .40).

Conclusions: Social risk factors were associated with increased ED utilization and hospitalizations at the patient level but were not significantly associated with time to subsequent acute care use. Future research should evaluate the effect of focused interventions on health care utilization, such as those addressing food insecurity and transportation challenges.

Keywords: food insecurity; health care utilization; health disparities; pediatric; social determinants of health; social risk factors.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Asthma* / epidemiology
  • Asthma* / therapy
  • Child
  • Emergency Service, Hospital*
  • Female
  • Hospitalization
  • Humans
  • Male
  • Retrospective Studies
  • Risk Factors