296 - High caregiver adverse childhood experiences are associated with increased pediatric infection-related healthcare utilization and antibiotic use

Poster Number: 296
Publication Number: 296.1847

Background: Higher caregiver adverse childhood experiences (ACEs) have been associated with a range of pediatric outcomes, including hospitalizations. We recently found that higher caregiver ACEs are associated with higher influenza vaccine uptake. However, no studies have examined links between caregiver ACEs and specific infections or infection-related outcomes, such as antibiotics prescribed.

Objective: To describe the association between caregiver ACEs and pediatric infection-related outcomes.

Design/Methods: We conducted a retrospective cohort study inclusive of children at two pediatric primary care settings, serving a predominantly Black, publicly insured population. Focusing on children 0-4 years of age, we retrieved data from the electronic health record, including demographic, social, and infection-related outcomes for those who had caregiver ACEs recorded. The number of reported caregiver ACEs was our exposure variable, dichotomized as high (≥4) or low (≤3). Our infection-related outcomes were specific infectious diagnoses, antibiotics prescribed, and healthcare utilization for infection-related concerns. To characterize the population, we also enumerated patient demographic characteristics, social risk screen results, and area deprivation index scores linked to patients’ geocoded home addresses. Bivariate assessments were pursued using chi square test statistics.

Results: A total of 1,432 children 0-4 years of age were included and were 50% female, 74.7% Black, and 2.6% Hispanic. Fifteen percent of caregivers had high (≥ 4) ACEs. Table 1 denotes differences in demographic and infection-related outcomes, based on high and low ACEs. Children of caregivers with high ACEs had more infection-related visits (89.9% versus 83.9%, p = 0.03), including diagnoses of streptococcal pharyngitis (10.1% versus 4.1%, p = 0.0004) and skin and soft tissue infections (14.3% versus 9.4%, p = 0.04). They also had more prescriptions for any oral antibiotic (29.5% versus 21.6%, p = 0.01).

Conclusion(s): High caregiver ACEs appear to be associated with some types of pediatric infectious diagnoses, antibiotic use, and increased infection-related healthcare utilization. Future adjusted evaluations of potential links between ACEs and infection-related outcomes, independent of variables like insurance status, social risk, and area-level deprivation, are warranted and planned.