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Race and insurance-status played role in decline of pediatric emergency department visits during 2020

  • February 16, 2022
Throughout 2020, the decline in pediatric emergency department visits among Black and public or self-insured patients was consistently larger than other demographics.

Streamed Ryals Public Health BuildingRyals Public Health Building
Photography: Bruce Southerland
Pediatric emergency department visits declined sharply throughout the United States during the initial months of the coronavirus pandemic. Results from a study at the University of Alabama at Birmingham show that relative declines in total emergency department visits, as well as high-severity visits, were larger in Black and economically disadvantaged groups, who were also likely to be public or self-insured. This decline could have a significant effect on pediatric public health in the future.

Using data from the Children’s of Alabama Emergency Department, Bisakha Sen, Ph.D., professor and Blue Cross Blue Shield Endowed Chair in the UAB School of Public Health, and  Pallavi Ghosh, M.D., assistant professor in UAB and Children’s Division of Pediatric Emergency Medicine, conducted an observational study focused on the role of racial and economic disparities in the overall decline of emergency department visits during 2020. The peer-reviewed study results were published in the PLOS ONE online journal.

Between 2015 and 2019, the Children’s emergency department saw approximately 72,000 pediatric patients per year. There was a combined total of 118,370 visits in 2019 and 2020. The sharpest decline in visits in 2020 occurred in April and May, with a 70 percent decline for Black and public and self-insured groups and 60 percent declines for non-Hispanic white and privately insured groups. Visits rebounded between June and September before declining again in November. Throughout the year, the decline in Black and public or self-insured patients was consistently larger than other study demographics.

“Prior to the pandemic, African American and economically disadvantaged communities disproportionately used emergency departments because they are often their only option for pediatric health care needs,” Sen said. “Given that the large declines in these populations included low- and high-severity visits, it is possible that many urgent health care needs went unmet for disadvantaged children.”

Stream Bisakha Sen UAB School of Public HealthBisakha Sen, Ph.D., professor and Blue Cross Blue Shield Endowed Chair in the UAB School of Public Health Photography: Steve WoodFindings indicated the unmet essential health care needs likely contributed to the worsening of pediatric health conditions and disparities among the minority and low-income communities. Just as the virus has caused “long-haul” health complications in patients, Sen suggests the forgoing of essential health care needs will also have a “long-haul” impact on pediatric health and the health care system.

“There has already been a decline in routine vaccination rates among children during the pandemic that has led to outbreaks of virus, such as the measles, that have not occurred in years,” Sen said. “Doctors and health care systems need to prepare for the ripple effect from these pandemic-related health care declines. Not only could they realistically see a higher number of sick patients in the future, but an increase in the severity of the illnesses of these patients.”

Additional studies have shown disadvantaged groups have taken on the financial brunt of the pandemic. Sen suggests financial disruption, paired with hesitancy in visiting health care organizations to avoid contracting the virus, played key roles in the large decline in pediatric emergency department visits in Black and public and self-insured demographics.

“In Alabama, more kids are on public insurance than on private plans, which could add additional stress on our health care system in the next few years,” said Anne Brisendine, DrPH, assistant professor in the UAB Department of Health Policy and Organization and study co-author. “At the end of the day, all children should receive appropriate and timely health care. The health system and providers need to start taking steps now to help minimize future health consequences from forgone pediatric emergency department care, particularly in disadvantaged populations.”

The study was funded through the Back of the Envelope Awards initiated by the UAB School of Public Health and the Sparkman Center for Global Health during COVID-19. Read the full study here. The UAB Division of Pediatric Emergency Medicine is part of the Marnix E. Heersink School of Medicine Department of Pediatrics.