Social deprivation, the Area Deprivation Index, and emergency department utilization within a community-based primary and preventive care program at a Florida medical school

IntroductionHigher Area Deprivation Index (ADI) scores, indicating higher social deprivation, have been associated with more frequent emergency department (ED) utilization. Access to clinical and social services can help prevent inappropriate ED use. A community-based medical school administering a primary and preventive care program focused on the social determinants of health (SDOH) tracks annual ED utilization by its households. This retrospective study determined household ADI scores and evaluated for associations with ED use.MethodsThe ADI uses 17 publicly available variables to assign composite scores of social deprivation at the block group level. The Green Family Foundation Neighborhood Health Education Learning Program at Florida International University provides outreach, clinical, and educational services to > 850 disadvantaged households. We conducted Poisson regression to evaluate the association between households' ADI scores and self-reported ED utilization over 2 calendar years.ResultsFor both the 2018 and 2019 cohorts, independent Poisson regression results indicate that ED visit count is significantly and inversely associated with ADI raw scores and deciles (p < 0.001).DiscussionBased on findings from earlier studies, we had hypothesized a positive, yet reduced association between annual ED utilization and ADI level but surprisingly, we found an inverse association. The combination of providing primary care and connecting with social and behavioral health services as needed appeared to reverse the expected higher ED use at higher ADI scores.ConclusionTracking of ED utilization in association with composite, area-based indices such as the ADI may prove useful for other clinical and community health endeavors focused on SDOH.