Food and housing insecurity, adverse childhood experiences, and pediatric emergency department use

Objective

To describe the relationship between neighborhood-level repression-adverse childhood experiences (ACEs) (family member incarceration, community violence, discrimination), food and housing insecurity, and pediatric emergency department (ED) utilization.

Methods

The measured exposures were food/housing insecurity, repression-ACEs, and childhood opportunity index (COI 3.0) based on caregiver/patient surveys and home address. The primary outcome was ED visits 12 months before and after the ED index visit. Multivariable regression models examined associations between the exposures and annual ED visit rates per 100 patients, adjusting for potential confounders.

Results

From March 2021 - May 2023 6228 patients (range 0–22 years) had an index ED visit. 64.9 % were Hispanic, 7.0 % Asian, 1.9 % Black, 7.0 % Other/multiple races, and 19.1 % White. Of the participants, 11.6 % had a repression-ACE; 22.3 % food or housing insecurity, and average COI was moderate (53.3, SD = 23.8). Food and housing insecurity were higher among Black (29.0 %) and Hispanic (26.3 %) participants (p < 0.001). Very low to moderate COI was highest in Black (51.3 %) and Hispanic (77.4 %) participants (p < 0.001). Black participants reported the highest repression-ACEs (25.6 %, p < 0.001). In univariate analyses, food insecurity (RR = 1.12, p = 0.07) and housing insecurity (RR = 1.13, p = 0.04) increased the ED visit rate. Experiencing discrimination increased this rate by 27 %, (RR = 1.27, p = 0.02). The effect of violence exposure (p = 0.03) and family member incarceration (p = 0.07) on ED visit rate varied across racial groups.

Conclusions

Repression-ACEs interact with race and ethnicity and social inequities (food/housing insecurity, COI) in shaping ED utilization. Impacts of ACEs on children’s health continue to shape inequities in pediatrics while defining areas for action.