Health-Related Social Problems Reported by Caregivers During Emergency Department Visits

Background: Social determinants of health (SDH) such as childhood poverty, parental unemployment, and domestic violence are known contributors to pediatric morbidity, adverse childhood experiences, and poor adult health and achievement. Yet, these social issues are often addressed individually or not at all in healthcare environments. Addressing SDH during an emergency department (ED) visit may provide an opportunity to intervene and improve the health of our most vulnerable children. To our knowledge, no prior studies have attempted to quantify and identify predictors of high numbers of SDH in the pediatric ED setting. Objective: To quantify SDH and behavioral risk factors that affect patients and families visiting a pediatric ED and to identify healthcare-related conditions (obesity, frequent non-urgent ED visits, and/or poor asthma control) that may be associated with high numbers of SDH. Design/Methods: This is an ongoing cross-sectional study of caregivers of patients ages 0-12 years who present to a high-volume, urban, pediatric ED. Participants completed an electronic questionnaire designed to identify SDH within 13 domains. We performed multivariable logistic regression analyses to identify whether endorsing high SDH (≥3) was associated with obesity (BMI percentile≥90), frequent non-urgent ED visits (≥ 3 ED visits in 12 months), or poor asthma control as measured by the PACCI-ED caregiver survey. Results: 285 caregivers were approached, and 118 (41%) completed the electronic survey. Almost half of the caregivers reported SDH involving safety (40%) and/or parental or child mental health (39%). Nearly 1/3 identified housing risk factors. Issues around health care access (25%) and poverty (23%) affected approximately 1 in 4 families. A majority of caregivers (79%) screened positive for at least one SDH. Over one-third of participants (38%) screened positive for at least three (3) SDH. Endorsing high SDH was not associated with obesity (aOR 2.154, 95% CI: 0.590-7.871), frequent non-urgent ED visits (aOR 1.9, 95% CI 0.6-5.8), or poor asthma control (aOR 0.959, 95% CI 0.793-1.161). Conclusion(s): The majority of caregivers presenting for care to a pediatric ED endorsed at least 1 SDH, with one- third endorsing a large number of SDH. Future research will incorporate assessment of SDH in adolescents and their caregivers, further study predictors that will identify patients at high risk for SDH who may benefit from proactive social intervention, and assess the impact of social interventions on ED recidivism and other patient outcomes