Lack of Association of Household Income and Acute Gastroenteritis Disease Severity in Young Children: A Cohort Study
To determine if low household income is associated with disease severity following emergency department (ED) discharge in children with acute gastroenteritis (AGE). We conducted a secondary analysis employing data collected in 10 US-based tertiary-care, pediatric EDs between 2014 and 2017. Participa...
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| Published in | Academic pediatrics Vol. 22; no. 4; pp. 581 - 591 |
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| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.05.2022
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| Subjects | |
| Online Access | Get full text |
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| Summary: | To determine if low household income is associated with disease severity following emergency department (ED) discharge in children with acute gastroenteritis (AGE).
We conducted a secondary analysis employing data collected in 10 US-based tertiary-care, pediatric EDs between 2014 and 2017. Participants were aged 3 to 48 months and presented for care due to AGE. Income status was defined based on 1) home ZIP Code median annual home income and 2) percentage of home ZIP Code households below the poverty threshold. The primary outcome was moderate-to-severe AGE, defined by a post-ED visit Modified Vesikari Scale (MVS) score ≥9. Secondary outcomes included in-person revisits, revisits with intravenous rehydration, hospitalization, and etiologic pathogens.
About 943 (97%) participants with a median age of 17 months (interquartile range 10, 28) completed follow-up. Post-ED visit MVS scores were lower for the lowest household income group (adjusted: -0.60; 95% confidence interval [CI]: -1.13, -0.07). Odds of experiencing an MVS score ≥9 did not differ between groups (adjusted odds ratio: 0.91; 95% CI: 0.54, 1.52). No difference in the post-ED visit MVS score or the proportion of participants with scores ≥9 was observed using the national poverty threshold definition. For both income definitions, there were no differences in terms of revisits following discharge, hospitalizations, and intravenous rehydration. Bacterial enteropathogens were more commonly identified in the lowest socioeconomic group using both definitions.
Lower household income was not associated with increased disease severity or resource use. Economic disparities do not appear to result in differences in the disease course of children with AGE seeking ED care. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 David Schnadower conceptualized and designed the study, designed the data collection instruments, coordinated and supervised data collection, reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work. T. Charles Casper conceptualized and designed the study, designed the data collection instruments, conducted the analysis, and reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work. Cheryl Vance coordinated and supervised data collection, reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work. Elizabeth C. Powell coordinated and supervised data collection, reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work. Karen O’Connell coordinated and supervised data collection, reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work. Robert Sapién coordinated and supervised data collection, reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work. Cindy Roskind coordinated and supervised data collection, reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work. Seema Bhatt coordinated and supervised data collection, reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work. Contributors Statement Thomas Chun conceptualized and designed the study, coordinated and supervised data collection, reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work. Cody Olsen conceptualized and designed the study, and conducted the analysis reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work. Phillip I. Tarr conceptualized and designed the study, designed the data collection instruments, coordinated and supervised data collection, reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work. Stephen B. Freedman conceptualized and designed the study, designed the data collection instruments, reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work. Alexander Rogers coordinated and supervised data collection, reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work. Prashant Mahajan coordinated and supervised data collection, reviewed and revised the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work. |
| ISSN: | 1876-2859 1876-2867 1876-2867 |
| DOI: | 10.1016/j.acap.2021.07.009 |