University of Alberta Research Reveals Children’s Social Circumstances Influence Outcomes in Emergency Care

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.”

The role of social determinants in health is an area of special interest for first author Sana Amjad, a doctoral student in Obstetrics & Gynecology and Women and Children’s Health Research Institute (WCHRI) scholar.

“Our review provides documented evidence that social determinants of health are not only affecting your risk of developing diabetes or hypertension or having a Caesarean section, but they also shape your experience in accessing health care starting at an early age,” Amjad says.

She says that factors such as socio-economic status, family status, language, and race affect the experiences children have in the emergency department, and whether they are admitted, how their treatment is managed or whether they leave without being seen.

The study was published in the Annals of Emergency Medicine, the discipline’s highest-impact journal, and was presented at the 22nd International Conference on Emergency Medicine, where it was selected as one of the top six abstracts.

The contributions of Amjad and other students were crucial to the research project, say both Ospina and Rowe.

“Their efforts represent steps researchers are taking to ensure better care for children, mitigating lifelong health challenges, and setting up families and communities for a lifetime of better health,” Rowe says.

This research received support from the Emergency Strategic Clinical Network, the Alberta Women’s Health Foundation through WCHRI, the Canada Research Chairs Program and the Canadian Institutes of Health Research.