Language and Demographic Disparities in Social Needs and Referral Preferences in the Pediatric ED

To examine disparities in unmet social needs (USNs) and caregiver interest in community resource center (CRC) referrals in the pediatric emergency department (PED), focusing on language preference, insurance, and race and ethnicity, and to explore predictors of referral interest.

This observational study utilized administrative data from the real-world prospective effectiveness parent study [5R01NR019944-04]. English- and Spanish-speaking caregivers of pediatric patients (<18 years) presenting to a free-standing, quaternary care, level 1 trauma center PED were recruited using convenience sampling through a research assistant program. Caregivers completed a 10-item social needs screener (p-SINCERE), followed by an opt-in referral opportunity to 211Utah, and child-specific demographic questions. Outcomes included USN prevalence (≥1 reported need) and caregiver interest in CRC referral. Descriptive statistics summarized characteristics, and multivariable logistic regression identified predictors of referral interest.

Of 18,319 caregivers approached, 16,909 (92.3%) completed the screener. USN prevalence was 47.2% among English-speaking, 78.3% among Spanish-speaking, and 53% among other-language caregivers. Overall, 15.4% expressed interest in CRC referral, including 9.8% of English-speaking, 53.3% Spanish-speaking, and 31.3% of other-language caregivers. Multivariable analysis revealed that Spanish language preference, public or no insurance, Hispanic ethnicity, and non-White racial backgrounds were independently associated with greater interest in referral. A "voltage drop" was observed between USN disclosure and referral interest.

Disparities in USNs and referral interest vary by language, insurance, and race and ethnicity. The gap between need identification and interest in connecting to resources highlights the need for linguistically and culturally responsive interventions and system-level strategies to advance health equity in the PED.