Background: Although healthcare systems aim to guarantee equitable care, socioeconomic determinants still affect both health outcomes and the quality of care delivered. In Spain, studies on these inequities remain limited due to the absence of health databases including socioeconomic data. Objective: To assess the impact of socioeconomic factors on pediatric care in Spanish pediatric emergency departments (PEDs). Design/Methods: A multicenter, retrospective study with prospective enrollment was conducted since November 2024 in 7 PEDs across Spain. Medical, socioeconomic, and potential confounding variables were collected through a questionnaire completed by caregivers after the medical consultation. Afterwards, patient medical records from the PED visits in the preceding two years were reviewed. Table 1 lists the collected variables. Data from the visit during which the patient was recruited were not included to avoid Hawthorne bias. A multivariate analysis was performed to analyze the association between each socioeconomic determinant included in the survey and clinical management. In addition, potential confounders such as hospital, patient’s age and vaccine status, consultation during night or weekend shifts, presence of underlying conditions, and triage level were also included. Patient inclusion continues; results are provisional. Results: We distributed 22,539 questionnaires, with a response rate of 11.8% (2,661 patients). Of these, 1,500 had at least one recorded visit in the previous two years, totaling 5,301 visits and a median of 2 per patient (IQR 1–4). Table 2 shows the results of the survey. After adjusting for potential confounders, children of same-sex couples (OR 0.71, 95%CI 0.55–0.92) and those born in Spain (OR 0.72, 95%CI 0.54–0.96) were less likely to receive blood tests. Compared to Mediterranean ethnicity, patients of Maghrebi origin were more likely to undergo X-rays (OR 1.95, 95%CI 1.14–3.35) but were prescribed fewer antibiotics (OR 0.38, 95%CI 0.16–0.90). Patients of sub-Saharan origin also received more X-rays (OR 4.24, 95%CI 1.09–16.55). Meanwhile, Spanish Roma (OR 0.10, 95%CI 0.01–0.77) and Afro-Latin patients (OR 0.51, 95%CI 0.30–0.86) were prescribed antibiotics less frequently. Additional associations for specific clinical scenarios are detailed in Table 3.
Conclusion(s): Socioeconomic determinants are significantly associated with variability in clinical decision-making and access to diagnostic tests and treatments in Spanish PEDs. These findings highlight the need to identify, thoroughly analyze, and address inequities in pediatric emergency care.
Table 1. Variables collected in the survey to the families and from the previous episodes. Table 1.pdf
Table 2. Results of the survey distributed to families and caregivers. Table 2.pdf*Other ethnicities include Andean American, Eastern European, Maghreb, Sub-Saharan African, Oriental, Spanish Roma, Afro-Latin Caribbean, Indo-Pakistani, and 'Other.'
Table 3. Main associations found. Only variables with p<0.05 in the multivariate models are included (CI, confidence interval; OR, odds ratio) Table 3.pdf1 Compared to Other ethnicities (include Andean American, Eastern European, Maghreb, Sub-Saharan African, Oriental, Spanish Roma, Afro-Latin Caribbean, Indo-Pakistani, and 'Other.')
