Higher ED visits among infants of mothers with disabilities

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Emergency department (ED) use is more common among infants of women with disabilities, according to a recent study published in JAMA Network Open.

Importance of identifying at-risk families

The odds of ED visits are greatest among infants aged under 1 year compared to all age groups, commonly caused by respiratory illness and fever. The ability to access timely care is often determined by infant ED visits, as these may be avoided through adequate care at birth and access to a primary care physician. However, a 30% increase in US pediatric ED visits has been observed in the past 15 years.²

“Identifying families at risk of infant ED visits is thus critical for informing tailored preventive measures, improved continuity of primary care, and appropriate ED supports,” wrote investigators.¹

The population-based cohort study was conducted to compare ED visits among infants of women with a physical, sensory, or intellectual or developmental disability vs those without a disability. Hospital, outpatient, and sociodemographic data was obtained from the research institute ICES, formerly the Institute for Clinical Evaluative Sciences.

Disability and ED visit identification

Live births from April 1, 2008, to March 31, 2021, without discharge to social services after birth were included in the analysis. Disability epidemiologists developed algorithms to identify patients with a physical, sensory, or intellectual disability or more than 1 of these disabilities based on diagnoses recorded in 2 or more physician visits or at least 1 ED visit.

Infants born to women without a disability were placed in the reference group. An ED visit within the first year of life was defined as the primary outcome of the analysis, defined as an unscheduled visit in a facility with 24/7 staffing for immediate care. These were identified in the National Ambulatory Care Reporting System dataset.

ED visits were also assessed based on the timing, including under 28 days after delivery and 28 to 365 days after delivery. The Canadian Triage and Acuity Scale score was also utilized to determine the urgency of care, with a score of 4 to 5 being low, 3 moderate, and 1 to 2 high.

Follow-up with a primary care physician was also assessed among infants with an ED visit. Covariates included infant sex, year of birth, and sociodemographic factors that impact health care.

Study population characteristics

There were 1,596,932 infants included in the final analysis, 8.7% of whom were born to women with a physical disability, 3% with a sensory disability, and 0.2% with an intellectual or developmental disability. Additionally, 0.6% were born to women with multiple disabilities, while 87.4% were born to women without any disabilities.

Most women were aged 25 to 34 years, with those with a sensory or intellectual, or developmental disability younger on average than those without a disability. The odds of living in a low-income neighborhood were also higher among women with an intellectual or developmental disability.

ED visit rates and risk analysis

An ED visit in the first year of life was reported in 40% of infants born to women without a disability, for an incidence rate of 1.11 per 1000 person-days. Among infants born to women with a physical disability, this rate rose to 46.9%, at 1.30 per 1000 person-days. This indicated an adjusted hazard ratio (aHR) of 1.14 among these patients.

Among infants born to women with sensory and intellectual or neurodevelopment disabilities, rates of ED visits in the first year of life were 45.2% and 55.4%, respectively. This indicated incidence rates of 1.25 and 1.55 per 1000 person-days, respectively, and aHRs of 1.09 and 1.24, respectively.

A rate of 51%, an incidence rate of 1.42 per 1000 person-days, and an AHR of 1.18 were reported for an ED visit among infants of women with multiple disabilities. Similar trends were reported for ED visits at under 28 days vs 28 to 365 days after delivery and based on acuity. This highlighted an overall increase in the risk of an ED visit among infants of women with a disability.

Implications and recommendations

“These findings suggest that more could be done for infants of women with a disability to prevent nonurgent ED visits, reduce risk factors for urgent ED visits, and support families when ED visits occur,” wrote investigators.

References:

1. Brown HK, Lunsky Y, Fung K, et al. Maternal disability and emergency department use for infants. JAMA Netw Open. 2025;8(5):e258549. doi:10.1001/jamanetworkopen.2025.8549
2. To T, Terebessy E, Zhu J, et al. Did emergency department visits in infants and young children increase in the last decade?: an Ontario, Canada study.Pediatr Emerg Care. 2022;38(4):e1173-e1178. doi:10.1097/PEC.0000000000002535