Differences in Declines in Pediatric ED Utilization During the Covid19 Pandemic by Socioeconomic Disadvantage.

BackgroundThere is growing evidence that the early months of the COVID19 pandemic saw substantial declines in pediatric Emergency Department (ED) utilization in the U.S. However, less is known about whether utilization changed differentially for children who are socio-economically disadvantaged. We examined how changes pediatric ED visits during the early months of the COVID19 pandemic differed by two markers of socio-economic disadvantage, minoritized race and being publicly insured. MethodsThis retrospective observational study used electronic medical records from a large pediatric ED in a Deep South state for January-June 2020. Three time-periods pre-COVID19 (TP0), COVID19 with restrictions like stay-at-home (TP1), and COVID19 with restrictions relaxed (TP2) in 2020 were compared with the corresponding time-periods in 2019. Changes in overall visits, visits for minoritized race (MR) versus non-Hispanic white (NHW) children, and Medicaid-enrolled versus privately-insured children were considered, and changes in acuity-mix of ED visits and share of visits resulting in inpatient admits were inspected. ResultsCompared to 2019, total ED visits declined in TP1 and TP2 of 2020 (54.3%, 48.9%). Declines were larger for MR children (57.3%, 57.8%) compared to NHW children (50.5%, 39.3%), and Medicaid enrollees (56.5%, 52.0%) compared to the privately insured (48.3%, 39.0%). Particularly, MR children saw steeper percentage declines in high-acuity visits and visits resulting in inpatient admissions compared to NHW children. The mix of pediatric patients by race and insurance-status, as well as the share of high-acuity visits and visits with inpatient admissions differed between TP1 and TP2 of 2019 and 2020 (p<0.05 for all cases). In contrast, there was little evidence of difference between TP0 of 2019 and 2020. ConclusionThe role of socioeconomic disadvantage and the potential impacts on pediatric ED visits during COVID19 in the Deep South of the United States changes is understudied. We find evidence of steeper declines in visits among MR and Medicaid-enrolled children, including for high-acuity conditions, than their NHW and privately-insured counterparts. Since disadvantaged children sometimes lack access to a usual source of care, this raises concerns about unmet health needs, and worsening health disparities, in a region that already has poor health indicators.