Prevalence of adversities related to social determinants of health among children with multiple emergency department visits

Document Type

Conference Proceeding

Publication Date


Publication Title

Academic Emergency Medicine


Background and Objectives: The emergency department (ED) is an important screening site for social determinants of health (SDH) among children. Therefore, we aimed to determine the prevalence of multiple SDH among children with frequent ED visits.

Methods: This is a cross-sectional study of data from the 2016-2018 National Surveys of Children's Health (NSCH), an annual nationally representative survey from the CDC including 102,341 children ages 0-17 in the United States. Survey weights were used for generation of population estimates. Children with ≥2 ED visits as reported by parent respondents were compared to children with 1 or 0 ED visits in the last year. Chi squared statistics and 95% confidence intervals of population estimates from the survey were used for statistical comparison.

Results: Overall, 80.1% of children ages 0-17 had no ED visit in the last year, 15.1% had 1 ED visit, and 4.8% had ≥2 ED visits in the last year. Compared to those with no ED visits, children with ≥2 ED visits were generally younger, of Black non-Hispanic race/ethnicity, experienced poverty (40.4% with ≥2 ED visits were at ≤100% of the federal poverty level versus 18.3% with no ED visit, p < 0.05), had public insurance, lived in unsafe communities (11.2% of children with ≥2 ED versus 4.6% of those with 0 ED visits, p < 0.05). Significantly more children with ≥2 ED visits were food insecure [13.3% (95% CI 11.0-15.7) ≥2 ED visits versus 5.2% (95% CI 4.7-5.6) no ED visit], had housing instability with ≥3 lifetime moves [34.4% (95% CI 29.6-39.3) ≥2 ED visits versus 24.6% (95% CI 23.8-25.3) no ED visit], and had ≥3 adverse childhood experiences [ACEs, 19.4% (95% CI 16.5-22.2) versus 8.9% (95% CI 8.4-9.3) no ED visit] compared to children with no ED visits. Children with ≥2 ED visits had nearly three times the unmet needs [7.7% (95% CI 6.1-9.3)] compared to those with no ED visits [2.7% (95% CI 2.4-3.0)]. Most children with ≥2 ED visits with unmet needs specifically identified unmet medical needs [44% (95% CI 30.7-57.2)].

Conclusion: Children with multiple ED visits have higher rates of adversity related to social determinants of health than do children with no ED visits, with notably higher rates of food and housing insecurity, ACEs, exposure to unsafe communities, and unmet medical needs. Support is necessary for interventions that screen and connect patients to resources at both an ED and national level.




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