A Nationwide Analysis of Acute Pediatric Healthcare Encounters Attributed to Substance Use Before, During, and Following the COVID-19 Pandemic

Abstract

Objective

To examine changes in acute health care encounters, and to identify risk factors associated with substance use among the pediatric population before, during, and after the COVID-19 pandemic.

Method

We conducted an interrupted time series analysis to assess changes in acute health care encounters related to substance use from 2017 to 2023 among a national sample of youth 6 to 17 years of age. Based on sociodemographic variables, logistic regression analyses were used to predict substance use encounters. We examined their interactions with the COVID-19 era to highlight differences in these acute encounters before, during, and after the pandemic.

Results

Records for more than 20 million acute health care encounters were examined among the pediatric population from 2017 through 2023. Of these records, 219,267 had substance use diagnoses. During the COVID-19 era, the proportion of encounters associated with substance use increased, and then post pandemic declined to pre-pandemic levels. The most common substances attributed to acute health care encounters were marijuana (n = 141,273) and alcohol (n = 45,147). Health care encounters attributed to substance use were more common in older youth (13-17 years of age), male youth, and youth who were American Indian or Alaska Native. Additional disparities were associated with certain substances, indicating the need for tailored public health and clinical interventions among these populations.

Conclusion

Although overall health care encounters dropped during the pandemic, the proportion of visits attributed to substance use increased significantly during that time. Of note, encounters attributed to marijuana use have remained elevated among youth. Unique risk factors may exist for health care encounters based on substance, warranting the need for additional research on these disparities.

Plain language summary

Using data from the Epic electronic health records’ Cosmos database to identify trends in acute healthcare encounters related to substance use before, during, and following the COVID-19 pandemic, over 20 million pediatric acute healthcare encounters were examined from 2017 through 2023. The authors found that the proportion of healthcare encounters related to substance use surged during the pandemic across all substance types. Post-pandemic, marijuana was the only substance for which healthcare encounters remained elevated. These findings highlight the need for ongoing research on the persistently elevated rate of marijuana-related healthcare.

Diversity & Inclusion Statement

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex balance in the selection of non-human subjects. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper self-identifies as living with a disability.