Kristin N. Ray (
Kristin A. Yahner is the General Academic Pediatrics Division data center coordinator, Department of Pediatrics, University of Pittsburgh School of Medicine.
Health Aff (Millwood). 2021 Jan;40(1):156-164. doi: 10.1377/hlthaff.2020.00675.
Children in communities with concentrated socioeconomic and structural disadvantage tend to have elevated rates of nonurgent visits to emergency departments (EDs). Using a spatial regression model of 264 census block groups in Pittsburgh, Pennsylvania, we investigated sociodemographic and structural factors associated with lower-than-expected ("low utilization") versus higher-than-expected ("high utilization") nonurgent ED visit rates among children in block groups with concentrated disadvantage. Compared with high-utilization block groups, low-utilization block groups had higher percentages of households with two adults, high school graduates, access to vehicles, sound housing quality, and owner-occupied housing. Notably, low-utilization block groups did not differ significantly from high-utilization block groups either in the percentage of households located within very close proximity to public transit or primary care or in children's health insurance coverage rates. Stakeholders wishing to reduce pediatric nonurgent ED visits among families in communities of concentrated disadvantage should consider strategies to mitigate financial, time, transportation, and health literacy constraints that may affect families' access to primary care.
在社会经济和结构性劣势集中的社区中，儿童往往会高频次地非紧急就诊于急诊部（ED）。我们利用宾夕法尼亚州匹兹堡市 264 个普查街区组的空间回归模型，调查了社会人口统计学和结构性因素，这些因素与在劣势集中的街区组中，儿童的非紧急 ED 就诊率低于预期（“低利用率”）与高于预期（“高利用率”）有关。与高利用率的街区组相比，低利用率的街区组中拥有两个成年人、高中毕业生、有交通工具、住房质量良好和自有住房的家庭比例更高。值得注意的是，低利用率的街区组与高利用率的街区组在靠近公共交通或初级保健的家庭比例或儿童医疗保险覆盖率方面没有显著差异。希望减少集中劣势社区中家庭的儿科非紧急 ED 就诊次数的利益相关者应考虑采取策略来减轻可能影响家庭获得初级保健的经济、时间、交通和健康素养方面的限制。
