Disparities by Race and Insurance-Status in Declines in Pediatric ED Utilization During the COVID19 Pandemic
Principal Investigator(s): View help for Principal Investigator(s) Bisakha Sen, UAB; Pallavi Ghosh, UAB School of Medicine
Version: View help for Version V1
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application/x-stata-dta | 57.1 KB | 01/04/2022 11:17:AM |
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application/x-stata-dta | 139.6 KB | 01/04/2022 11:10:AM |
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application/x-stata-dta | 2.2 MB | 01/04/2022 11:04:AM |
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text/plain | 4.2 KB | 01/04/2022 11:15:AM |
Project Citation:
Sen, Bisakha, and Ghosh, Pallavi. Disparities by Race and Insurance-Status in Declines in Pediatric ED Utilization During the COVID19 Pandemic. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2022-01-04. https://doi.org/10.3886/E152201V1
Project Description
Summary:
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The purpose was to explore disparities in changes in pediatric ED visits during the COVID19 pandemic in one tertiary ED compared to the preceding year, and explore whether this changes differed by race and by insurance status. The uploaded data files (Stata v17, .dta files) include aggregated daily data, and individual data without PHI. The abstract of the "in press' manuscript is as follows:
ABSTRACT
Pediatric Emergency Department (ED) utilization in the U.S. saw large declines during the COVID19 pandemic. What is relatively unexplored is whether the extent of declines differed by race and insurance status. An observational study was conducted using electronic medical record (EMR) data from the largest pediatric ED in Alabama for 2020 and 2019. The four subgroups of interest were African-American (AA), Non-Hispanic White (NHW), privately insured (PRIVATE), and publicly insured or self-insured (PUBLIC-SELF). Percentage changes in the 7-day moving average between dates in 2020 and 2019 were computed for total and high-severity ED visits by subgroup. Trends in percentage changes were plotted. T-tests were used to compare mean changes between subgroups. Large percentage declines in total ED visits and somewhat smaller percentage declines in high-severity visits were observed from March 2020. Declines were consistently larger for AA than NHW and for PUBLIC-SELF than PRIVATE. T-test results indicated mean date-specific percentage declines were significantly larger for AA than NHW for total visits (-38.92% [95% CI: -41.1, -36.8] versus -29.11% [95% CI: -30.8, -27.4]; p<0.001) and high-severity visits (-24.31% [95% CI: -26.2, -22.4] versus -19.49% [95% CI:-21.2, -17.8]; p<0.001), and larger for PUBLIC-SELF than PRIVATE for total visits (-36.32% [95% CI:-38.4, -34.3] versus 27.63% [95% CI:-29.2, -26.0]; p<0.001) and high-severity visits (-21.72% [95% CI: -23.5, -19.9] versus -20.01% [95% CI: -21.7, -18.3]; p=0.04). Significant differences by race and insurance status were observed in the decline in ED visits during the COVID19 pandemic, including high-severity visits. Minority-race and publicly insured or self-insured children often depend on the ED for health needs, lacking a usual source of care. Thus, these findings have worrisome implications regarding unmet healthcare needs and future exacerbations in health disparities.
ABSTRACT
Pediatric Emergency Department (ED) utilization in the U.S. saw large declines during the COVID19 pandemic. What is relatively unexplored is whether the extent of declines differed by race and insurance status. An observational study was conducted using electronic medical record (EMR) data from the largest pediatric ED in Alabama for 2020 and 2019. The four subgroups of interest were African-American (AA), Non-Hispanic White (NHW), privately insured (PRIVATE), and publicly insured or self-insured (PUBLIC-SELF). Percentage changes in the 7-day moving average between dates in 2020 and 2019 were computed for total and high-severity ED visits by subgroup. Trends in percentage changes were plotted. T-tests were used to compare mean changes between subgroups. Large percentage declines in total ED visits and somewhat smaller percentage declines in high-severity visits were observed from March 2020. Declines were consistently larger for AA than NHW and for PUBLIC-SELF than PRIVATE. T-test results indicated mean date-specific percentage declines were significantly larger for AA than NHW for total visits (-38.92% [95% CI: -41.1, -36.8] versus -29.11% [95% CI: -30.8, -27.4]; p<0.001) and high-severity visits (-24.31% [95% CI: -26.2, -22.4] versus -19.49% [95% CI:-21.2, -17.8]; p<0.001), and larger for PUBLIC-SELF than PRIVATE for total visits (-36.32% [95% CI:-38.4, -34.3] versus 27.63% [95% CI:-29.2, -26.0]; p<0.001) and high-severity visits (-21.72% [95% CI: -23.5, -19.9] versus -20.01% [95% CI: -21.7, -18.3]; p=0.04). Significant differences by race and insurance status were observed in the decline in ED visits during the COVID19 pandemic, including high-severity visits. Minority-race and publicly insured or self-insured children often depend on the ED for health needs, lacking a usual source of care. Thus, these findings have worrisome implications regarding unmet healthcare needs and future exacerbations in health disparities.
Funding Sources:
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University of Alabama at Birmingham School of Public Health (Internal grant)
Scope of Project
Subject Terms:
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pediatrics;
emergency departments;
health disparities;
covid;
race;
insurance
Geographic Coverage:
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Alabama
Time Period(s):
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1/2019 – 12/2020
Collection Date(s):
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1/1/2019 – 12/31/2020 (Daily data from 1/2019 to 12/2020)
Universe:
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Children 0-18
Data Type(s):
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medical records
Collection Notes:
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Electronic medical records
Methodology
Response Rate:
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not applicable
Sampling:
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All patient records within above dates
Data Source:
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EMR from Children's of Alabama Pediatric ED
Collection Mode(s):
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other
Unit(s) of Observation:
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Patients per day
Geographic Unit:
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ED level
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