Emergency Department and Hospital Use Among Adolescents With Justice System Involvement

Adolescents with justice system involvement have high rates of physical and behavioral health disorders and are potentially high users of costly health care services. We examined emergency department (ED) and hospital use among a national sample of adolescents with various levels of justice involvement.

Cross-sectional analysis using the 2009 to 2014 National Survey on Drug Use and Health. We included adolescents aged 12 to 17 and used multivariable logistic and negative binomial regression models, adjusting for sociodemographic and health differences, to compare ED and hospital use among adolescents with and without justice involvement.

Our sample included 1375 adolescents with past year arrest, 2450 with past year probation or parole, 1324 with past year juvenile detention, and 97 976 without past year justice involvement. In adjusted analyses, adolescents with any justice system involvement, compared to those without, were more likely to have used the ED (38.5%-39.5% vs 31.0%; P < .001) or been hospitalized in the past 12 months (7.1%-8.8% vs 4.8%; P < .01). After adjustment, adolescents with justice involvement also had more ED visits per 100 person-years (77.7-92.9 vs 62.8; P < .01) and hospital nights per 100 person-years (43.3-53.7 vs 18.0; P < .01). Use was highest among adolescents with justice involvement who reported fair or poor health, an illicit drug use disorder, or a mood disorder.

Adolescents with justice involvement had substantially higher rates of ED and hospital use. Providing comprehensive support services to adolescents with justice involvement may improve health care use patterns and reduce health care spending.