Social context factors and disparities in emergency department use in pediatric food allergy

Background: Although disparities in food allergy (FA) related emergency department (ED) use exist, social context factors are understudied and may play an important role. Objective: We sought to evaluate the role of food security and community resources in explaining disparities in FA-related ED usage. Methods: Electronic medical record data from Hasbro Children’s Hospital’s FA clinic were extracted from January 1, 2016, to December 31, 2021, for children ages < 18 years. Diagnostic classification codes and chart reviews were used to identify encounters with immunoglobulin E (IgE) mediated FA-related diagnoses. We evaluated the differences in FA-related ED use by age, race and/or ethnicity, community resources (Child Opportunity Index [COI]), and the percentage of households in the census tract that receive Supplemental Nutrition Assistance Program (SNAP) benefits. Logistic regression was performed to identify predictors of FA-related ED use. Results: A total of 1,512 children were seen at the FA clinic for IgE-mediated FA. Those who used the ED for FA were non-Latino White (NLW) (16.1%), Black (22.0%), Latino (23.1%), and Other (23.5%) (standardized mean difference [SMD], 0.10; p < 0.05). The risk of FA-related ED visits differed by age, with fewer visits for older children (odds ratio [OR], 0.7), and by social economic and neighborhood environment variables, with a lower risk of ED visits for more resourced environments (ORs for public insurance, 1.57; OR for SNAP, 1.19; and OR for COI, 0.80). Disparities in ED usage became negligible for patients already connected to routine allergist care, which demonstrated a potential protective factor. Conclusion: Black and Latino children have an increased risk for FA-related ED visits compared with NLW children, although social contextual factors explained most of the disparities. Analysis of the findings demonstrates the need to consider the social economic and neighborhood environment in FA management to inform place-based interventions.