Objective

To evaluate associations of race/ethnicity and social determinants with 90-day rehospitalization for mental health conditions to acute care nonpsychiatric children's hospitals.

Study design

We conducted a retrospective cohort analysis of mental health hospitalizations for children aged 5-18 years from 2016 to 2018 at 32 freestanding US children's hospitals using the Children's Hospital Association's Pediatric Health Information System database to assess the association of race/ethnicity and social determinants (insurance payer, neighborhood median household income, and rurality of patient home location) with 90-day rehospitalization. Risk factors for rehospitalization were modeled using mixed-effects multivariable logistic regression.

Results

Among 23 556 index hospitalizations, there were 1382 mental health rehospitalizations (5.9%) within 90 days. Non-Hispanic Black children were 26% more likely to be rehospitalized than non-Hispanic White children (aOR 1.26, 95% CI 1.08-1.48). Those with government insurance were 18% more likely to be rehospitalized than those with private insurance (aOR 1.18, 95% CI 1.04-1.34). In contrast, those living in a suburban location were 22% less likely to be rehospitalized than those living in an urban location (suburban: aOR 0.78, 95% CI 0.63-0.97).

Conclusions

Non-Hispanic Black children and those with public insurance were at greatest risk for 90-day rehospitalization, and risk was lower in those residing in suburban locations. Future work should focus on upstream interventions that will best attenuate social disparities to promote equity in pediatric mental healthcare.

中文翻译：

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种族/民族和社会决定因素与急症儿童医院精神健康状况再住院的关系

客观的

旨在评估种族/族裔和社会决定因素与因精神健康问题而在急性护理非精神病儿童医院 90 天再住院之间的关系。

学习规划

我们使用儿童医院协会的儿科健康信息系统数据库，对 2016 年至 2018 年 32 家独立的美国儿童医院 5-18 岁儿童的心理健康住院情况进行了回顾性队列分析，以评估种族/民族与社会决定因素（保险）之间的关系。付款人、社区家庭收入中位数以及患者家庭所在地的农村地区）以及 90 天再住院。使用混合效应多变量逻辑回归对再住院的危险因素进行建模。

结果

在 23 556 例住院治疗中，90 天内有 1,382 例精神健康再住院（5.9%）。非西班牙裔黑人儿童再住院的可能性比非西班牙裔白人儿童高 26%（aOR 1.26，95% CI 1.08-1.48）。拥有政府保险的人再住院的可能性比拥有私人保险的人高 18%（aOR 1.18，95% CI 1.04-1.34）。相比之下，居住在郊区的患者再次住院的可能性比居住在城市的患者低 22%（郊区：aOR 0.78，95% CI 0.63-0.97）。

结论

非西班牙裔黑人儿童和拥有公共保险的儿童在 90 天再住院的风险最大，而居住在郊区的儿童的风险较低。未来的工作应侧重于上游干预措施，以最好地缩小社会差距，促进儿科心理保健的公平性。