Kids in Tough Neighborhoods Head to ER More Often

Kids in Tough Neighborhoods Head to ER More Often

Growing up in a disadvantaged neighborhood may mean more visits to the emergency room, a new study suggests.

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When children came from areas of "low opportunity," they were about one-third more likely to have been treated at an urgent care center or an emergency room than kids from areas with more opportunity.

They were also twice as likely to receive care for an assault-related injury compared to kids in the "highest opportunity" areas.

"Health care studies often look at income for a neighborhood, but we thought more broadly about what in a child's neighborhood could affect their health care," explained study author Ellen Kersten, a research specialist at the University of California, San Francisco.

An area of low opportunity isn't just one where people are living in poverty. Instead, the investigators looked at a number of factors, such as:

  • Percentage of school students receiving free lunch,
  • Kids' proficiency in reading and math,
  • Access to early childhood education and participation in these programs,
  • Percentage of adults who attend college,
  • Access to health facilities,
  • Access to healthy food,
  • Proximity to toxic waste,
  • Parks and open spaces,
  • Unemployment and public assistance rates.

For the study, the researchers looked at areas across San Francisco. The study included more than 47,000 youths under 18 who visited an emergency department or urgent care center between 2007 and 2011.

Almost 40 percent of the kids seen in ERs or urgent care centers were seen for respiratory conditions. Fifteen percent of those were diagnosed with asthma. More than a third of the children were seen for conditions that could usually be handled during a doctor visit. About one-third of the visits were due to injury or trauma.

The researchers then looked to see what type of neighborhoods these children were growing up in. They also compared low opportunity neighborhoods to those traditionally defined as low income, based on U.S. Census data. While these areas often overlapped, areas of low opportunity covered more area.

Kersten said this shows that when studies only look at an area's income, they may miss people who need health care assistance.

Race and ethnicity played big roles in areas with low opportunity.

"More than 3 out of every 4 African-American or Latino patients in our sample lived in a low opportunity neighborhood compared with just 1 out of every 4 white patients," Kersten noted.

"And 82 percent of publicly insured patients lived in low opportunity neighborhoods, compared with 27 percent of privately insured patients. These disparities in neighborhood child opportunity translate into disparities in child health," she added.

Because each low opportunity neighborhood has different challenges, the reasons behind the increased ER and urgent care visits vary, Kersten said.

And that means the solution to this problem will need to be individualized by community, "but could include investments in public schools and day cares, improving access to healthy food and parks, and expanding local hiring and housing assistance programs," she added.

Dr. Peter Richel, chief of pediatrics at Northern Westchester Hospital in Mount Kisco, N.Y., reviewed the findings.

"Emergency departments are overutilized by those in the lower income brackets. It's sad to me that not all children have a relationship with a primary care provider," he said.

"While ER doctors are great and well-trained, they're not ideal for routine care for children," Richel explained. "They don't know the patient's history. They don't follow them from newborn to 21, and ERs can be intimidating.

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"It's also not ideal from the health care side. It's taxing to the facilities and it's expensive to spend money on highly qualified ER talent to sometimes treat a cold," he noted.

The study was published online April 6 in the journal Pediatrics.

More information

Learn about choosing a pediatrician from the American Academy of Pediatrics.


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