Published online February 1, 2005
PEDIATRICS Vol. 115 No. 2 February 2005, pp. e147-e151 (doi:10.1542/peds.2004-1798)
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ELECTRONIC ARTICLE

Association Between Parental and Childhood Emergency Department Utilization

Rakesh D. Mistry, MD*, Raymond G. Hoffmann, PhD{ddagger}, Jennifer S. Yauck, MS§ and David C. Brousseau, MD, MS*

* Section of Pediatric Emergency Medicine, Department of Pediatrics
{ddagger} Department of Biostatistics, Health Policy Institute
§ Department of Epidemiology, Health Policy Institute, Medical College of Wisconsin, Milwaukee, Wisconsin

Objective. To examine the association between parental emergency department (ED) utilization and child ED utilization for overall numbers of ED visits, as well as numbers of nonurgent ED visits.

Methods This was a secondary data analysis of the 2000 Medical Expenditure Panel Survey, a nationally representative survey of health care utilization. The numbers of overall self-reported ED visits were collected for parents and a single child randomly selected from each family. Negative binomial linear regression, with clustering within families, was used to determine the association between parental ED and child ED use, controlling for potential confounders. The analysis was repeated for nonurgent ED visits, classified with standard and modified versions of previously published criteria.

Results. The mean age of the 3182 children analyzed was 9.4 years; 51% were male, 18.1% were publicly insured, and 8.2% were uninsured. The mean number of overall ED visits in 2000 was 0.17 visits per year for the children (95% confidence interval [CI]: 0.15–0.19 visits per year), 0.18 visits per year for the mothers (95% CI; 0.15–0.21 visits per year), and 0.11 visits per year for the fathers (95% CI: 0.09–0.13 visits per year). Each maternal ED visit was associated with 1.30 additional child ED visits (95% CI: 1.07–1.59 visits); each paternal ED visit was associated with an additional 1.33 child ED visits (95% CI: 1.07–1.65 visits). The relationship between parental and child nonurgent ED visits was even more pronounced.

Conclusions. Increased parental ED utilization is significantly associated with increased childhood ED utilization. Parental patterns of ED use may have implications for childhood ED use. Future interventions aimed at decreasing ED utilization should focus on parental or family utilization.

Key Words: emergency services • hospital • health services • utilization • nonurgent emergency care

Abbreviations: ED, emergency department • MEPS, Medical Expenditure Panel Survey • IRR, incidence rate ratio • CI, confidence interval

Accepted Sep 22, 2004.


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