Social determinants of health and emergency and hospital use by children with chronic disease

Hosp Pediatr

Objectives: To evaluate the association between caregiver-reported social determinants of health (SDOH) and emergency department (ED) visits and hospitalizations by children with chronic disease. Methods: This was a nested retrospective cohort study (December 2015 to May 2017) of children (0–18 years) receiving Supplemental Security Income and Medicaid enrolled in a case management program. Caregiver assessments were coded for 4 SDOH: food insecurity, housing insecurity, caregiver health concerns, and safety concerns. Multivariable hurdle Poisson regression was used to assess the association between SDOH with ED and hospital use for 1 year, adjusting for age, sex, and race and ethnicity. ED use was also adjusted for medical complexity. Results: A total of 226 children were included. Patients were 9.1 years old (SD: 4.9), 60% male, and 30% Hispanic. At least 1 SDOH was reported by 59% of caregivers, including food insecurity (37%), housing insecurity (23%), caregiver health concerns (18%), and safety concerns (11%). Half of patients had an ED visit (55%) (mean: 1.5 per year [SD: 2.4]), and 20% were hospitalized (mean: 0.4 per year [SD: 1.1]). Previously unaddressed food insecurity was associated with increased ED use in the subsequent year (odds ratio: 3.43 [1.17–10.05]). Among those who had ≥1 ED visit, the annualized ED rate was higher in patients with a previously unaddressed housing insecurity (rate ratio: 1.55 [1.14–2.09]) or a safety concern (rate ratio: 2.04 [1.41–2.96]). Conclusions: Over half of caregivers of children with chronic disease enrolled in a case management program reported an SDOH insecurity or concern. Patients with previously unaddressed food insecurity had higher ED rates but not hospitalization rates.

Foster CC, Simon TD, Qu P, et al. Social determinants of health and emergency and hospital use by children with chronic disease. Hosp Pediatr. 2020;10(6):471‐480. PMID: 32423995. DOI: 10.1542/hpeds.2019-0248.

Publication Year: 
Resource Type: 
Peer Reviewed Research
Study Design: 
Pre-post without Comparison Group
Children and Youth
Complex Patients
Screening Research: