Exploring the role of discretionary income as a social determinant of health.

OBJECTIVE: The object of this study is to explore the impact of discretionary income on the overall well-being of Americans. DATA SOURCE: The data source used for this study was 2017 Behavioral Risk Factor Surveillance System data comprising 12 states that used the Social Determinants of Health (SDOH) module. STUDY DESIGN: Multivariable logistic regression models were used to analyze the relationship between discretionary income and self-reported health status after adjusting for common SDOH measures, sociodemographic factors, chronic conditions, and perspectives and experiences of respondents regarding specific aspects of their health. Average marginal effects (AME) were reported. DATA COLLECTION/EXTRACTION METHODS: Not applicable. PRINCIPAL FINDINGS: At all income levels, those with discretionary income at the end of the month were 6-7 percentage points more likely to report better than average health than those with none, controlling for other factors (AME: 0.07, 95% CI: 0.02-0.12). CONCLUSION: Our study suggests that discretionary income has a role to play in overall health and well-being that goes beyond that of disposable income and may be an important resource for diverse communities.

Predictors of Pediatric Frequent Emergency Department Use Among 7.6 million Pediatric Patients in New York.

OBJECTIVE: This study examines the characteristics and factors associated with frequent emergency department (ED) utilization among the pediatric population. METHODS: We conducted a pooled cross-sectional secondary analysis using the Healthcare Cost and Utilization Project State Emergency and Inpatient Databases on ED visits to all hospitals in New York from 2011 to 2016 by patients aged 0 to 21. We used multivariable logistic and negative binomial regressions to investigate the predictors of multiple ED visits in the pediatric population. RESULTS: Overall, our study included 7.6 million pediatric patients who accounted for more than 12 million ED visits. Of those, 6.2% of patients were frequent ED users (≥4 visits/year), accounting for 20.8% of all ED visits (5.4 ED visits/year on average). The strongest predictors of frequent ED use were having at least one ED visit related to asthma (aOR = 8.37 [95% CI: 6.34-11.04]), mental health disorders (aOR = 9.67 [95% CI: 8.60-10.89]), or multiple comorbidities compared to none. Larger shares of ED visits for not-emergent conditions were also associated with frequent ED use (aOR = 6.63 [95% CI = 5.08-8.65]). Being covered by Medicaid compared to private (aOR = 0.45 [95% CI: 0.42-0.47]) or no insurance (aOR = 0.41 [95% CI: 0.38-0.44]) were further associated with frequent ED use. The results from the negative binomial regression yielded consistent findings. CONCLUSIONS: Pediatric patients who exhibit increased ED use are more medically complex and have increased healthcare needs that are inextricably tied to social determinants of health. Better integrated health systems should emphasize connecting vulnerable patients to appropriate social and primary care services outside of emergency settings.