Maternal Disability and Emergency Department Use for Infants.

Importance: Infants have among the highest rates of emergency department (ED) visits of all age groups. Women with disabilities experience significant social disparities, may experience barriers accessing child primary care, and may seek care in the ED.

Objective: To compare ED use among newborns and infants (hereafter infants) of women with or without disabilities, overall and by timing and acuity of the ED visit.

Design, setting, and participants: This population-based cohort study analyzed data for all live-born infants in Ontario, Canada, born to women with or without a disability from April 1, 2008, to March 31, 2021. Data were analyzed March 2023 to October 2024.

Exposure: Maternal physical, sensory, or intellectual or developmental disability or multiple disabilities status was ascertained using diagnostic algorithms applied to health care encounters before delivery.

Main outcomes and measures: The main outcome was any ED visit between an infant's hospitalization discharge date and their first birthday, and by timing and acuity. Cox proportional hazards regression was used to generate hazard ratios (HRs) for the association between maternal disability and the main outcome, adjusted for sociodemographic characteristics and infant sex and year of birth.

Results: Of 1 596 932 total infants, there were 139 698 (8.7%) born to women with a physical disability, 48 112 (3.0%) to women with a sensory disability, 2547 (0.2%) to women with an intellectual or developmental disability, and 10 312 (0.6%) to women with multiple disabilities. The remaining 1 396 263 infants (87.4%) were born to a woman without a recognized disability. Among women without a disability, 558 965 infants (40.0%) had an ED visit in the first year of life (incidence rate, 1.11 per 1000 person-days). Compared with this referent group, infants born to a woman with a disability of a physical (46.9%; 1.30 visits per 1000 person-days; adjusted HR [AHR], 1.14 [95% CI, 1.13-1.15]), sensory (45.2%; 1.25 visits per 1000 person-days; AHR, 1.09 [95% CI, 1.07-1.10]), or intellectual or developmental (55.4%; 1.55 visits per 1000 person-days; AHR, 1.24 [95% CI, 1.17-1.30]) nature or with multiple disabilities (51.0%; 1.42 visits per 1000 person-days; AHR, 1.18 [95% CI, 1.15-1.22]) were more likely to have an ED visit. Similar patterns were observed for ED visits at fewer than 28 days from delivery, from 28 to 365 days, and for ED visits for high-acuity, moderate-acuity, and low-acuity reasons.

Conclusions and relevance: In this population-based cohort study, infants of women with disabilities were more likely to use the ED, indicating a need for accessible family supports and improved early child primary care access.