New research has found that social determinants of health — including race, language and socio-economic deprivation — shape how children and their families seek care at emergency departments.
In a systematic review and meta-analysis, the research paper evaluated 58 studies, mostly from the United States and Canada, involving more than 17 million children who made 103 million emergency department visits. The study was the first of its kind in the world, and researchers looked for links between social determinants and emergency department outcomes in pediatric populations.
"The negative impact of social determinants on the health outcomes of children is an important topic to explore and understand," says principal investigator Maria Ospina, adjunct professor of Obstetrics and Gynecology at the University of Alberta and associate professor of Public Health Sciences at Queen's University.
This study's findings are important because adverse social determinants of health disproportionally affect children. Early or prolonged exposures to social risk can lead to increased hospitalizations, poor overall health and worse outcomes in chronic conditions. Increased use of emergency departments by children from racial minorities, including Indigenous populations, and lower socio-economic status groups also reflect barriers to accessing primary health care through family physicians.
The researchers also found that patients who spoke a first language other than English were more likely to be hospitalized, to stay longer and to leave hospital against medical advice.
Screening needed
The findings point to the need for a better way to collect and quantify these social determinants for patients in emergency departments, says Brian Rowe, one of the co-authors and a professor in Emergency Medicine at U of A.
"Emergency medicine is one of the primary ways people access the health-care system. Twenty years ago, we were not having these conversations about social determinants of health," he says. "This study shows the need to create a screening tool to assess the social risks or needs based on social determinants, and how we deal with those as emergency medicine practitioners."
