O0492 Oct.4: 5:04pm - Neighborhood Conditions and Recurrent Emergency Department Utilization by Children in the United States

Introduction: Recurrent emergency department (ED) utilization in the pediatric population is associated with multiple individual-level factors, including minority race and ethnicity and lower household income. How neighborhood conditions experienced by families, particularly social and physical environmental attributes that are potentially amenable to intervention, influence child ED utilization is less well understood.

Objective: Evaluate the associations of neighborhood cohesion, safety, amenities (sidewalks, parks, recreation centers, libraries), and detractors (litter, rundown housing, vandalism) with child recurrent ED utilization and their contribution to utilization differences by race and ethnicity and income level.

Methods: Cross-sectional study of data from the National Survey of Children’s Health from 2016 to 2018. Bivariate analyses with chi square tests were performed to examine neighborhood characteristic prevalence by race and ethnicity and household income level and associations with the primary outcome of recurrent ED utilization, defined as having multiple ED visits in the past year. Multivariable regression determined the neighborhood associations with recurrent ED utilization adjusted for individual-level covariates of race and ethnicity, household income level, insurance type, consistency of insurance coverage, primary household language, family structure, parent/caregiver educational attainment, and presence of special healthcare needs. Regression models were compared with and without neighborhood characteristics included to assess the degree to which they accounted for differences in recurrent ED utilization by race and ethnicity and by income.

Results: Nationally, Hispanic and non-Hispanic black children and children in lower-income households were more likely to live in neighborhoods that were not cohesive, unsafe, and affected by detractors (Figure). Overall, 4.8% of children had multiple ED visits in the past year. Children living in neighborhoods that were not cohesive, unsafe, or affected by detractors were significantly more likely to have had multiple ED visits in the past year; there was no significant association with neighborhood amenities (Table). After adjustment for individual-level covariates, only neighborhood detractors remained significantly associated with recurrent ED utilization (one detractor aOR: 1.29, 95% CI: 1.03–1.63; two or three detractors aOR: 1.34, 95% CI: 1.04–1.74) (Table). Associations of minority race and ethnicity and poverty with recurrent ED utilization were not significantly changed by adjustment for neighborhood characteristics.

Conclusion: Recurrent ED utilization was more common among children living in neighborhoods that were not cohesive, unsafe, or affected by detractors, with neighborhood detractors emerging as the strongest independent risk factor. Neighborhood-level interventions to address issues of the physical environment such as poor housing conditions may potentially reduce the frequency of and alleviate disparities in child ED visits and associated healthcare costs.