579 - Deep Disadvantage and Pediatric Readiness: Exploring Disparities in Pediatric Emergency Care Across US Counties

Publication Number: 1556.579

Anna Bauman, University of Michigan Medical School, Ann Arbor, MI, United States; James A.. Cranford, University of Michigan, Ann Arbor, MI, United States; Hilary Hewes, University of Utah School of Medicine, Salt Lake City, UT, United States; Emily Mathias, University of Michigan Medical School, Ann Arbor, MI, United States

Background: Pediatric readiness in emergency departments (EDs) saves lives, yet readiness scores vary widely across the United States. The Index of Deep Disadvantage (IDD) captures multidimensional poverty beyond traditional economic measures, incorporating factors including life expectancy, social mobility, and health outcomes.The relationship between community-level deep disadvantage and ED pediatric readiness remains unexplored.

Objective: To examine the relationship between county-level IDD scores and weighted pediatric readiness scores (wPRS) in EDs. Secondary objective was to characterize counties without corresponding wPRS to identify barriers to pediatric emergency care access. We hypothesized that greater community disadvantage would be associated with lower wPRS.

Design/Methods: Cross-sectional analysis merged 2021 NPRP assessment data (N=3,646 EDs) with county-level IDD data using FIPS codes. After exclusions, the final sample included 3,431 EDs from 1,926 counties. Pearson correlations examined associations between IDD (total and components) and wPRS. Secondary analysis compared IDD profiles of counties with versus without participating EDs (n=1,926 vs n=1,193).

Results: The correlation between IDD and wPRS was positive and statistically significant (r=.06, p<.001). Visual examination revealed a nonlinear, quadratic relationship: IDD was associated with increasing wPRS at lower IDD levels (higher disadvantage), plateauing at average to high IDD levels (lower disadvantage) (Figure 1). Component analyses showed differential associations: higher rates of poverty (r=-.10, p<.001) and deep poverty (r=-.07, p<.001) correlated with lower wPRS; higher life expectancy correlated with higher wPRS (r=.20, p<.001). Social mobility was inversely associated with wPRS (r=-.17, p<.001). Low birth weight showed no significant correlation with wPRS (r=-.002, p=.90) (Table 1). Counties with participating EDs had higher mean IDD scores than those without (M=.10 vs M=-.09, p=.005) (Table 2). These counties may represent non-participating EDs or absence of an ED, a critical distinction for understanding pediatric emergency care gaps.

Conclusion(s): The relationship between deep disadvantage and pediatric readiness was significant but nonlinear. Some IDD components showed stronger associations with pediatric readiness than the composite score. Counties with the deepest disadvantage were less likely to have NPRP data, representing either non-participating EDs or absence of an ED. Distinguishing between readiness versus access gaps is critical for targeting interventions to improve pediatric emergency care in vulnerable communities.

Figure 1. Relationship between Index of Deep Disadvantage and Pediatric Readiness Scores
Figure 1.pdfScatterplot showing relationship between county-level IDD (higher scores=lower disadvantage) and weighted Pediatric Readiness Score (wPRS) for 3,431 U.S. EDs (r =.06, p<.001).

Table 1. Associations Between County-Level Disadvantage Measures and Emergency Department Pediatric Readiness Scores (N=3,431)
Table 1.pdfr=Pearson correlation coefficient. Higher IDD scores indicate lower community disadvantage. **p <.001. Correlation magnitude classified as weak (|r| <.30), moderate (.30≤|r| <.50), or strong (|r|≥.50). Level of analysis is the emergency department with county-level IDD data.

Table 2. County Disadvantage Profiles: EDs With vs. Without NPRP Participation
Table 2.pdfED=Emergency Department; M=mean; SD=standard deviation. Higher IDD scores indicate lower community disadvantage. p-values are from independent samples t-tests comparing counties with versus without EDs participating in the 2021 National Pediatric Readiness Project Assessment.