TOPLINE

According to a population-based study, youth living in neighborhoods with lower Child Opportunity Index (COI) scores had significantly higher rates of emergency department (ED) visits for mental health conditions than those living in neighborhoods with higher COI scores. The association remained significant after adjustment for demographic and geographic factors.

METHODOLOGY

• Researchers conducted a retrospective, population-based cross-sectional study of youth aged 5-19 years who presented with primary mental health diagnoses to 254 nonpsychiatric acute care hospitals in Kansas and Missouri during federal fiscal years 2022 and 2023.
• A total of 52,362 mental health ED visits among 1.79 million youth were included. Neighborhood opportunity was assessed using zip code-level COI 3.0 categories ranging from very low to very high.
• The primary outcome was the annual rate of mental health ED visits per 1000 youth by COI level.
• Researchers evaluated factors associated with mental health ED visit rates using multivariable Poisson regression adjusted for state, rural-urban commuting area, health professional shortage area status, age, sex, and year.

TAKEAWAY

• Youth living in very low-COI neighborhoods had higher rates of mental health ED visits than those living in very high-COI neighborhoods (17.0 vs 10.1 per 1000 youth; P < .001).
• After adjusting for state, rural-urban commuting area, health professional shortage area status, age, sex, and year, the rates of mental health ED visits were 74% higher in very low- than in very high-COI zip codes (adjusted rate ratio [aRR], 1.74; P < .001).
• The rates of mental health ED visits were 79% higher in Missouri than in Kansas (aRR, 1.79; P < .001) and 47% higher in urban areas than in isolated small rural towns (aRR, 1.47; P < .001).
• Health professional shortage area status was not significantly associated with mental health ED visit rates (aRR, 1.07; P = .08).

IN PRACTICE

"In this population-based cross-sectional study, youth living in lower-opportunity zip codes had significantly greater rates of ED visits for MH [mental health] diagnoses. These results may reflect greater prevalence of MH conditions or suboptimal outpatient health care access. Further investigation is necessary to examine the causal mechanisms for these disparities and if specific neighborhood-level factors influence youth MH ED health care utilization," the authors wrote.

SOURCE

The study was led by Shelby Chesbro, MD, Children's Mercy Kansas City, Kansas City, Missouri. It was published online on June 22, 2026, in JAMA Pediatrics.

LIMITATIONS

The study could not capture health insurance status, ED visits outside Kansas and Missouri, or repeated visits by individual patients. Mental health ED visits were identified using primary diagnosis codes, potentially underestimating the true burden. Race and ethnicity were not included in adjusted analyses. Zip code-based analyses may not have accurately reflected neighborhood characteristics and were subject to ecologic fallacy.

DISCLOSURES

The study did not receive any funding. The authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.