Impact of Ethnicity and Social Determinants of Health on Pediatric Primary Care During the COVID-19 Pandemic

Background: The COVID-19 pandemic has exacerbated already-existing health disparities and inequities among minority and lower socioeconomic status groups. The increased health and financial burdens are expected to have both immediate and long-term impacts on the health of children from these vulnerable backgrounds. This study examines the relationship between ethnicity, social determinants of health (SDH), and measures of health outcomes for children during the COVID-19 pandemic.

Methods: This retrospective study reviewed the electronic medical record of 1235 in-person well child visits (ages <18) occurring from August 2020 through February 2021 at Loyola University Medical Center’s (LUMC’s) pediatric primary care clinic in Maywood, IL. The records were reviewed for the results of their SDH screening in the domains of food, financial, and transportation insecurity. The association between ethnicity, unmet SDH domains, routine medical care delay, vaccine delays, and utilization of acute and emergency department (ED) visits were evaluated.

Results: There was an association between ethnicity and self-reported unmet SDH screening results. Black, Hispanic, and Asian patients had higher rates of reported unmet SDH than their White peers (p <.001, Table 1). There was a statistically significant increase in delays to well child visits (WCV) for patients with positive SDH screens (p <.001). Although there was no association between ethnicity and delay in well child visits (WCV), there was a statistically significant increase in delays for well child visits for patients with at least 1 unmet SDH domain (mean: 144.7 days, median: 35 days) compared to those without any unmet needs (mean: 97.8 days, median: 8 days) (p <.001).

Positive SDH screens were also associated with increased likelihood of acute care utilization, (p= <.001), increased frequency of acute care visits (p=.02), increased likelihood of ED utilization (p <.001), and increased frequency of emergency department utilization (p <.01) (Table 2).

Conclusion: The results suggest that the impact of COVID-19 upon the disruption of routine well child care has not been homologous. Ethnicity was associated with an increased rate of unmet SDH domains. Unmet SDH domains were associated with delays in WCV, increased acute care visits, and increased ED utilization.