A Comparative Analysis of Injury Prevalence and Health Care Utilization Among Children In and Out of Foster Care in New Jersey
Open Access DepositedBackground. Children in foster care (FC) are a special needs population with increased susceptibility to acute and long-term health challenges. Yet little is known about injury patterns among this population despite injuries being the leading cause of death among children and adolescents in the U.S. Purpose. Grounded in the Injury Equity Framework, this study assessed and compared injury prevalence and health care utilization among children in and out of FC who were seen within a single hospital network. Methods. Using the New Jersey Safety and Health Outcomes (NJ-SHO) Data Warehouse and Children’s Hospital of Philadelphia health records (2016-2022), children 0-18 years old residing in NJ were categorized as being in FC or not in FC. Analytic variables included injury diagnosis codes, socio-demographic characteristics (sex, age, race/ethnicity, and insurance status), community equity measures (child opportunity index (COI) and population density), health care utilization by department (emergency department/urgent care (ED/UC), primary care (PC), and specialty care (SC)), injury severity, and injury intent. Descriptive statistics, prevalence ratios, multivariable regression models, and negative binomial models assessed differences in injury prevalence, including pre-, during-, and post-COVID-19 shutdown periods, and health care utilization. Results. Approximately half of the study cohorts were male (53.7% FC
52.7% non-FC). The median age at first visit for the FC cohort was 3 (IQR 0,8) and 7 for the non-FC cohort (IQR 1,12). Children in FC were more racially and ethnically diverse and were primarily publicly insured, compared to children not in FC who were mostly privately insured. Injury prevalence was comparable between the FC and non-FC cohorts, at 18.7% and 18.4%, respectively, with no statistically significant differences in odds of injury after adjusting for socio-demographic covariates. Children in FC tended to live in areas of lower neighborhood-level opportunity compared to children not in FC (p = 0.002 for overall COI), though there were no statistically significant associations with odds of injury by FC status when adjusting for child opportunity levels and population density. Across the COVID-19 study periods, children in FC had lower odds of injury compared to children not in FC. When assessing health care utilization, there were no statistically significant associations with FC status and rates of overall visits or by utilization measure when adjusting for socio-demographic covariates. However, descriptive analyses found children in FC had higher proportions of ED/UC and PC visits, lower SC utilization, and more intentional injury-associated visits compared to children not in FC. Trends indicated that children in FC had higher proportions of moderate injury severity and child abuse-related injuries compared to children not in FC. Conclusions. While overall injury prevalence is similar between the two cohorts, meaningful differences are evident by community opportunity and resources, health care utilization, injury mechanisms, and injury severity. These findings highlight the need for increased study of injuries among children in FC, targeted clinical training, improved data infrastructure linking health and social outcomes, and policies addressing intersectional risks to support long-term health among children in FC.
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Mohammed_gwu_0075A_17799.pdf | 2026-06-24 | Open Access |
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