Association between socioeconomic status and nonurgent presentations to pediatric emergency departments: a retrospective study.

Abstract

Background and importance: Access to healthcare remains a persistent challenge. Socially disadvantaged populations often encounter barriers to care and may frequently seek out emergency departments (EDs), including for nonurgent medical care.

Objective: The objective of this study is to study the association between nonurgent presentations to pediatric EDs and patients' socioeconomic environment in an urban setting.

Design, setting, and participants: A retrospective study of all visits to a pediatric ED in eight participating centers of the Paris metropolitan area (France) between 1 January 2017 and 31 December 2021 was carried out. Routinely collected data were analyzed.

Exposure: Socioeconomic status was evaluated using ecological variables defined at the municipality level. These variables were collected from public sources and included a social deprivation index, the accessibility to general practitioners, the proportion of single-parent families, and the proportion of immigrants.

Outcome measure and analysis: The primary endpoint was a nonurgent ED presentation, defined as being assigned one of the two lowest triage categories on a five-point scale. A multilevel logistic model assessed the association between nonurgent ED presentations and patients' characteristics, socioeconomic environment, and healthcare accessibility.

Main results: Nonurgent visits accounted for 51.6% of the 1 499 108 visits during the study period. The admission rate was 2.1% for nonurgent presentations and 18.8% for urgent presentations. In the final multivariate model (n = 1 412 895 visits), after adjustment for sex, age, time of day, day of the week, month, and year, the risk of nonurgent presentation was significantly higher for children living in less advantaged areas and in areas where the rate of single-parent families was high. It was also higher for children living close to the ED.

Conclusion: This extensive retrospective multicenter study emphasizes the increased risk of visiting EDs for nonurgent medical care among children from disadvantaged urban areas.