Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.
Children's Hospital Association, Lenexa, Kansas.
JAMA Netw Open. 2024 Oct 1;7(10):e2435059. doi: 10.1001/jamanetworkopen.2024.35059.
Pediatric emergency department (ED) visits for substance use (SU) increased during COVID-19. Better understanding of trends associated with SU ED visits among youths with a chronic medical condition (CMC) is needed to target SU screening, prevention, and intervention efforts in this population.
To describe trends in pediatric SU ED visits before and during COVID-19 among youths in the US with and without CMCs and by race and ethnicity.
DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, data were obtained from 47 US children's hospital EDs in the Pediatric Health Information System (PHIS) between March 1, 2018, and March 1, 2022. The cohort included patients aged 10 to 18 years. Data analysis occurred from November 2022 to February 2023.
ED visit occurrence before or during the COVID-19 pandemic and with or without the presence of a CMC. CMCs included chronic conditions (CCs) and complex CCs (CCCs).
The primary outcome was the number of visits for an SU diagnosis based on diagnostic codes for youths with and without CMCs. Trends were assessed using logistic regression, adjusting for covariates and center effect.
The sample included 3 722 553 ED visits from March 1, 2018, to March 1, 2022 (1 932 258 aged 14-18 years [51.9%]; 1 969 718 female [52.9%]; 961 121 Hispanic [25.8%]; 977 097 non-Hispanic Black [26.2%]; 1 473 656 non-Hispanic White [39.6%]). Of all visits, 1 016 913 (27.3%) were youths with CCs and 367 934 (9.9%) were youths with CCCs. Youth SU ED visits increased for all groups during COVID-19. The SU ED visits increased by 23% for youths with CCs (21 357 visits [4.0%] to 23 606 visits [4.9%]), by 26% for youths with CCCs (3594 visits [1.9%] to 4244 visits [2.4%]), and by 50% for youths without CCs (4997 visits [0.4%] to 5607 visits [0.6%]). Furthermore, compared with youths without CCs, youths with CCs had consistently larger odds of SU than the other groups before COVID-19 (adjusted odds ratio, 9.74; 99% CI, 9.35-10.15) and during COVID-19 (adjusted odds ratio, 8.58; 99% CI, 8.25-8.92). The interaction between race and ethnicity and CMCs was significant (P for interaction < .001).
The findings of this cohort study suggest that providing SU services to all youths during times of societal crises is critical, but particularly for youths with CMCs who experience higher potential health impacts from SU given their medical concerns.
在 COVID-19 期间，因药物使用（substance use，SU）而前往儿科急诊部（emergency department，ED）的就诊人数有所增加。为了有针对性地在这一人群中开展 SU 筛查、预防和干预工作，我们需要更好地了解与患有慢性疾病（chronic medical condition，CMC）的青少年相关的 SU ED 就诊趋势。
描述美国患有和不患有 CMC 的青少年在 COVID-19 之前和期间因 SU 前往儿科 ED 的就诊趋势，并按种族和民族进行描述。
设计、地点和参与者：本队列研究的数据来自于 2018 年 3 月 1 日至 2022 年 3 月 1 日期间在 47 家美国儿童医院的儿科健康信息系统（Pediatric Health Information System，PHIS）中的数据。该队列包括年龄在 10 至 18 岁之间的患者。数据分析于 2022 年 11 月至 2023 年 2 月进行。
COVID-19 大流行之前或期间发生的 ED 就诊，以及是否存在 CMC。CMC 包括慢性疾病（chronic condition，CC）和复杂 CCC（complex chronic condition，CCC）。
主要结局是根据有和无 CMC 的青少年的诊断代码，SU 诊断的就诊次数。采用 logistic 回归评估趋势，调整了协变量和中心效应。
该样本包括 2018 年 3 月 1 日至 2022 年 3 月 1 日期间的 3722553 次 ED 就诊（14-18 岁 1932258 例[51.9%]；女性 1969718 例[52.9%]；西班牙裔 961121 例[25.8%]；非西班牙裔黑人 977097 例[26.2%]；非西班牙裔白人 1473656 例[39.6%]）。在所有就诊中，有 1016913 例（27.3%）为患有 CC 的青少年，367934 例（9.9%）为患有 CCC 的青少年。在 COVID-19 期间，所有群体的 SU ED 就诊均有所增加。患有 CC 的青少年的 SU ED 就诊增加了 23%（21357 次就诊[4.0%]至 23606 次就诊[4.9%]），患有 CCC 的青少年的 SU ED 就诊增加了 26%（3594 次就诊[1.9%]至 4244 次就诊[2.4%]），而不患有 CC 的青少年的 SU ED 就诊增加了 50%（4997 次就诊[0.4%]至 5607 次就诊[0.6%]）。此外，与不患有 CC 的青少年相比，患有 CC 的青少年在 COVID-19 之前（调整后的优势比，9.74；99%置信区间，9.35-10.15）和 COVID-19 期间（调整后的优势比，8.58；99%置信区间，8.25-8.92）SU 的可能性一直更大。种族和民族与 CMC 之间的交互作用具有统计学意义（P<0.001）。
本队列研究的结果表明，在社会危机时期，为所有青少年提供 SU 服务至关重要，但对于患有 CMC 的青少年来说尤其重要，因为他们的医疗问题可能会对 SU 产生更高的潜在健康影响。
