Association Between Health-Related Social Needs and Pediatric Hospitalization Outcomes

BACKGROUND AND OBJECTIVES: Health-related social needs (HRSNs) are linked to worse health outcomes and increased low-value acute care use. HRSN impact on hospital length of stay (LOS) and other inpatient metrics remain underexplored. We aimed to evaluate the association between HRSNs and adverse health care utilization outcomes. Our primary outcome was LOS. Secondary outcomes included pediatric intensive care unit (PICU) admission, 30-day readmission, and 30-day emergency department (ED) revisit. METHODS: This is a retrospective cohort study of hospitalized pediatric patients screened for HRSNs between November 1, 2023, and October 31, 2024. Multivariable mixed-effects regression was used to assess the association between outcomes and having 1 or more HRSNs. Models were adjusted for sociodemographic characteristics, presence of medical complexity, admission month, and exposure to community health workers. An exploratory analysis assessed interactions between medical complexity and HRSNs on LOS. RESULTS: Among 3645 encounters, 1049 (28.8%) reported at least 1 HRSN. In adjusted models, having 1 or more HRSNs was associated with a 0.45-days-longer LOS (95% CI, 0.23-0.67) and 38% higher odds of PICU admission (adjusted odds ratio, 1.38; 95% CI, 1.02-1.86). There were no significant associations with 30-day readmission or ED revisit. Patients with both 1 or more HRSNs and medical complexity had an estimated 3.13-days-longer LOS (95% CI, 2.48-3.78) than those with neither. CONCLUSIONS: Unmet HRSNs are associated with longer LOS and greater likelihood of PICU admission. Children with medical complexity who have unmet social needs may particularly benefit from targeted social care interventions. Future work should assess the impact of such interventions on key hospitalization measures.