• Ye Liu, Pradeep Sharma, David J Becker, Anne Brisendine, Julie McDougal, Michael A Morrisey, Justin Blackburn, Nir Menachemi, Teela Sanders, and Bisakha Sen.
• Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL 35294. Email: yeliu@uab.edu.
• Am J Manag Care. 2023 Mar 1; 29 (3): 159164159-164.

ObjectivesInjuries are the leading cause of death among children and youth in the United States, representing a major concern to society and to the public and private health plans covering pediatric patients. Data from ALL Kids, Alabama's Children's Health Insurance Program, were used to evaluate the relationship between community-level social determinants of health (SDOH) and pediatric emergency department (ED) use and differences in these associations by age and race.Study DesignThis was a retrospective, pooled cross-sectional analysis.MethodsWe used ALL Kids data to identify ED visits (injury and all-cause) among children who were enrolled at any time from 2015 to 2017. Exploratory factor analysis was used to categorize SDOH from 18 selected Census tract-level variables. Multilevel Poisson regression models were used to evaluate the effects of community and individual factors and their interactions.ResultsCensus tract-level SDOH were grouped as low socioeconomic status (SES), urbanicity, and immigrant-density factors. Low SES and urbanicity factors were associated with ED visits (injury and all-cause). The low SES and urbanicity factors also moderated the association between race and ED visits (injury and all-cause).ConclusionsThe environment in which children live influences their ED use; however, the impact varies by age, race, and Census tract factors. Further studies should focus on specific community factors to better understand the relationship among SDOH, individual characteristics, and ED utilization.

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