{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T23:17:33Z","timestamp":1774048653129,"version":"3.50.1"},"reference-count":46,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Infants have among the highest rates of emergency department (ED) visits of all age groups. Women with disabilities experience significant social disparities, may experience barriers accessing child primary care, and may seek care in the ED.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare ED use among newborns and infants (hereafter infants) of women with or without disabilities, overall and by timing and acuity of the ED visit.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This population-based cohort study analyzed data for all live-born infants in Ontario, Canada, born to women with or without a disability from April 1, 2008, to March 31, 2021. Data were analyzed March 2023 to October 2024.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Maternal physical, sensory, or intellectual or developmental disability or multiple disabilities status was ascertained using diagnostic algorithms applied to health care encounters before delivery.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The main outcome was any ED visit between an infant\u2019s hospitalization discharge date and their first birthday, and by timing and acuity. Cox proportional hazards regression was used to generate hazard ratios (HRs) for the association between maternal disability and the main outcome, adjusted for sociodemographic characteristics and infant sex and year of birth.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 1\u202f596\u202f932 total infants, there were 139\u202f698 (8.7%) born to women with a physical disability, 48\u202f112 (3.0%) to women with a sensory disability, 2547 (0.2%) to women with an intellectual or developmental disability, and 10\u202f312 (0.6%) to women with multiple disabilities. The remaining 1\u202f396\u202f263 infants (87.4%) were born to a woman without a recognized disability. Among women without a disability, 558\u202f965 infants (40.0%) had an ED visit in the first year of life (incidence rate, 1.11 per 1000 person-days). Compared with this referent group, infants born to a woman with a disability of a physical (46.9%; 1.30 visits per 1000 person-days; adjusted HR [AHR], 1.14 [95% CI, 1.13-1.15]), sensory (45.2%; 1.25 visits per 1000 person-days; AHR, 1.09 [95% CI, 1.07-1.10]), or intellectual or developmental (55.4%; 1.55 visits per 1000 person-days; AHR, 1.24 [95% CI, 1.17-1.30]) nature or with multiple disabilities (51.0%; 1.42 visits per 1000 person-days; AHR, 1.18 [95% CI, 1.15-1.22]) were more likely to have an ED visit. Similar patterns were observed for ED visits at fewer than 28 days from delivery, from 28 to 365 days, and for ED visits for high-acuity, moderate-acuity, and low-acuity reasons.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this population-based cohort study, infants of women with disabilities were more likely to use the ED, indicating a need for accessible family supports and improved early child primary care access.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.8549","type":"journal-article","created":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T15:00:28Z","timestamp":1746457228000},"page":"e258549","source":"Crossref","is-referenced-by-count":1,"title":["Maternal Disability and Emergency Department Use for Infants"],"prefix":"10.1001","volume":"8","author":[{"given":"Hilary K.","family":"Brown","sequence":"first","affiliation":[{"name":"Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"},{"name":"Women\u2019s College Research Institute, Women\u2019s College Hospital, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yona","family":"Lunsky","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada"},{"name":"Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kinwah","family":"Fung","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Santiago-Jimenez","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andi","family":"Camden","sequence":"additional","affiliation":[{"name":"Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Edwin SH Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eyal","family":"Cohen","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Edwin SH Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada"},{"name":"Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel G.","family":"Ray","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natasha R.","family":"Saunders","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Edwin SH Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada"},{"name":"Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deanna","family":"Telner","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine E.","family":"Varner","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Schwartz\/Reisman Emergency Medicine Institute, Toronto, Ontario, Canada"},{"name":"Department of Emergency Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone N.","family":"Vigod","sequence":"additional","affiliation":[{"name":"Women\u2019s College Research Institute, Women\u2019s College Hospital, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Zwicker","sequence":"additional","affiliation":[{"name":"Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Astrid","family":"Guttmann","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Edwin SH Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada"},{"name":"Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2025,5,5]]},"reference":[{"issue":"5","key":"zoi250313r3","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1097\/PEC.0000000000000120","article-title":"Emergency department visits in the neonatal period in the United States.","volume":"30","author":"Lee","year":"2014","journal-title":"Pediatr Emerg Care"},{"issue":"6","key":"zoi250313r4","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1097\/00006565-200212000-00001","article-title":"Characteristics of nonurgent emergency department use in the first 3 months of life.","volume":"18","author":"Pomerantz","year":"2002","journal-title":"Pediatr Emerg Care"},{"issue":"4","key":"zoi250313r5","doi-asserted-by":"publisher","first-page":"e1173","DOI":"10.1097\/PEC.0000000000002535","article-title":"Did emergency department visits in infants and young children increase in the last decade?: an Ontario, Canada study.","volume":"38","author":"To","year":"2022","journal-title":"Pediatr Emerg Care"},{"issue":"8","key":"zoi250313r6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0203316","article-title":"Emergency department crowding: a systematic review of causes, consequences and solutions.","volume":"13","author":"Morley","year":"2018","journal-title":"PLoS One"},{"issue":"3","key":"zoi250313r7","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1097\/00006565-200006000-00001","article-title":"Early neonatal presentations to the pediatric emergency department.","volume":"16","author":"Millar","year":"2000","journal-title":"Pediatr Emerg Care"},{"issue":"6","key":"zoi250313r8","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1097\/PEC.0000000000002723","article-title":"Factors affecting nonurgent pediatric emergency department visits and parental emergency overestimation.","volume":"38","author":"Pehlivanturk-Kizilkan","year":"2022","journal-title":"Pediatr Emerg Care"},{"issue":"2","key":"zoi250313r9","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/j.ajog.2019.10.096","article-title":"Rates of recognized pregnancy in women with disabilities in Ontario, Canada.","volume":"222","author":"Brown","year":"2020","journal-title":"Am J Obstet Gynecol"},{"issue":"12","key":"zoi250313r10","doi-asserted-by":"publisher","first-page":"1564","DOI":"10.1089\/jwh.2019.8273","article-title":"Preconception health characteristics of women with disabilities in Ontario: a population-based, cross-sectional study.","volume":"29","author":"Tarasoff","year":"2020","journal-title":"J Womens Health (Larchmt)"},{"issue":"3","key":"zoi250313r11","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1007\/s10995-015-1848-1","article-title":"Disparities in adverse preconception risk factors between women with and without disabilities.","volume":"20","author":"Mitra","year":"2016","journal-title":"Matern Child Health J"},{"issue":"3","key":"zoi250313r12","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1080\/19371910903240969","article-title":"Health disparities between women with and without disabilities: a review of the research.","volume":"25","author":"Wisdom","year":"2010","journal-title":"Soc Work Public Health"},{"issue":"10","key":"zoi250313r13","doi-asserted-by":"publisher","first-page":"3542","DOI":"10.1007\/s10803-018-3615-9","article-title":"Emergency department use: common presenting issues and continuity of care for individuals with and without intellectual and developmental disabilities.","volume":"48","author":"Durbin","year":"2018","journal-title":"J Autism Dev Disord"},{"issue":"3","key":"zoi250313r14","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1352\/1944-7558-126.3.203","article-title":"Ambulatory care sensitive conditions among all-payer claimants with intellectual and developmental disabilities.","volume":"126","author":"Phillips","year":"2021","journal-title":"Am J Intellect Dev Disabil"},{"issue":"4","key":"zoi250313r16","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2024-066069","article-title":"Maternal disability and early child preventive care.","volume":"154","author":"Brown","year":"2024","journal-title":"Pediatrics"},{"issue":"6","key":"zoi250313r17","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1111\/jir.12159","article-title":"Mothers with intellectual impairment and their 9-month-old infants.","volume":"59","author":"Hindmarsh","year":"2015","journal-title":"J Intellect Disabil Res"},{"issue":"4","key":"zoi250313r18","first-page":"312","article-title":"Primary health care for children of mothers with intellectual limitations.","volume":"22","author":"Bowling","year":"1996","journal-title":"Pediatr Nurs"},{"issue":"pt 6","key":"zoi250313r19","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1111\/j.1365-2788.2008.01061.x","article-title":"Women with intellectual disability at risk of adverse pregnancy and birth outcomes.","volume":"52","author":"McConnell","year":"2008","journal-title":"J Intellect Disabil Res"},{"issue":"3","key":"zoi250313r20","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1016\/j.dhjo.2019.01.004","article-title":"Pregnancy course, infant outcomes, rehospitalization, and mortality among women with intellectual disability.","volume":"12","author":"Mueller","year":"2019","journal-title":"Disabil Health J"},{"issue":"4","key":"zoi250313r21","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"issue":"3","key":"zoi250313r24","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1016\/j.whi.2016.12.007","article-title":"Primary cesarean delivery patterns among women with physical, sensory, or intellectual disabilities.","volume":"27","author":"Darney","year":"2017","journal-title":"Womens Health Issues"},{"issue":"5","key":"zoi250313r25","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1111\/jir.12002","article-title":"Using administrative health data to identify individuals with intellectual and developmental disabilities: a comparison of algorithms.","volume":"57","author":"Lin","year":"2013","journal-title":"J Intellect Disabil Res"},{"issue":"2","key":"zoi250313r26","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.34993","article-title":"Association of pre-existing disability with severe maternal morbidity or mortality in Ontario, Canada.","volume":"4","author":"Brown","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"4","key":"zoi250313r28","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1542\/peds.2004-0015","article-title":"Follow-up after a pediatric emergency department visit: telephone versus e-mail?","volume":"114","author":"Goldman","year":"2004","journal-title":"Pediatrics"},{"issue":"4","key":"zoi250313r29","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1017\/cem.2017.40","article-title":"Return visits to the pediatric emergency department: a multicentre retrospective cohort study.","volume":"20","author":"Meyer-Macaulay","year":"2018","journal-title":"CJEM"},{"issue":"1 Pt 2","key":"zoi250313r31","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1542\/peds.106.S1.205","article-title":"Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980-1997.","volume":"106","author":"Feudtner","year":"2000","journal-title":"Pediatrics"},{"issue":"5","key":"zoi250313r32","first-page":"408","article-title":"Quantifying the adequacy of prenatal care: a comparison of indices.","volume":"111","author":"Alexander","year":"1996","journal-title":"Public Health Rep"},{"issue":"6","key":"zoi250313r33","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/j.jaac.2017.03.012","article-title":"Emergency department as a first contact for mental health problems in children and youth.","volume":"56","author":"Gill","year":"2017","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"6","key":"zoi250313r34","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.1080\/03610910902859574","article-title":"Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research.","volume":"38","author":"Austin","year":"2009","journal-title":"Commun Stat Simul Comput"},{"issue":"408","key":"zoi250313r35","doi-asserted-by":"publisher","first-page":"1074","DOI":"10.1080\/01621459.1989.10478874","article-title":"The robust inference for the Cox proportional hazards model.","volume":"84","author":"Lin","year":"1989","journal-title":"J Am Stat Assoc"},{"key":"zoi250313r36","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1214\/aos\/1176345976","article-title":"Cox\u2019s regression model for counting processes: a large sample study.","author":"Andersen","year":"1982","journal-title":"Ann Stat"},{"issue":"7","key":"zoi250313r37","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1093\/aje\/kwh090","article-title":"A modified Poisson regression approach to prospective studies with binary data.","volume":"159","author":"Zou","year":"2004","journal-title":"Am J Epidemiol"},{"issue":"6","key":"zoi250313r38","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1177\/0962280211427759","article-title":"Extension of the modified Poisson regression model to prospective studies with correlated binary data.","volume":"22","author":"Zou","year":"2013","journal-title":"Stat Methods Med Res"},{"issue":"4","key":"zoi250313r39","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1016\/j.clp.2013.07.008","article-title":"Hospital readmissions and emergency department visits in moderate preterm, late preterm, and early term infants.","volume":"40","author":"Kuzniewicz","year":"2013","journal-title":"Clin Perinatol"},{"issue":"3","key":"zoi250313r40","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-055318","article-title":"Neonatal outcomes of mothers with a disability.","volume":"150","author":"Brown","year":"2022","journal-title":"Pediatrics"},{"issue":"6","key":"zoi250313r41","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0128927","article-title":"Understanding low-acuity visits to the pediatric emergency department.","volume":"10","author":"Farion","year":"2015","journal-title":"PLoS One"},{"issue":"1","key":"zoi250313r42","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/s12905-021-01189-5","article-title":"Barriers in access to healthcare for women with disabilities: a systematic review in qualitative studies.","volume":"21","author":"Matin","year":"2021","journal-title":"BMC Womens Health"},{"key":"zoi250313r43","doi-asserted-by":"publisher","DOI":"10.1016\/j.chiabu.2022.105515","article-title":"Child protection involvement of children of mothers with intellectual disability.","volume":"126","author":"Lima","year":"2022","journal-title":"Child Abuse Negl"},{"issue":"6","key":"zoi250313r44","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1542\/peds.113.6.1619","article-title":"Impact of early newborn discharge legislation and early follow-up visits on infant outcomes in a state Medicaid population.","volume":"113","author":"Meara","year":"2004","journal-title":"Pediatrics"},{"key":"zoi250313r45","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.ridd.2017.10.010","article-title":"Implementation and evaluation of health passport communication tools in emergency departments.","volume":"72","author":"Heifetz","year":"2018","journal-title":"Res Dev Disabil"},{"issue":"2","key":"zoi250313r46","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1111\/1468-0009.t01-1-00007","article-title":"Using administrative data to study persons with disabilities.","volume":"80","author":"Iezzoni","year":"2002","journal-title":"Milbank Q"},{"key":"zoi250313r1","volume-title":"Healthcare Cost and Utilization Project (HCUP) Statistical Briefs","author":"McDermott","year":"2018"},{"key":"zoi250313r2","volume-title":"Healthcare Cost and Utilization Project (HCUP) Statistical Briefs","author":"Weiss","year":"2014"},{"key":"zoi250313r22","volume-title":"Summary of Studies on the Quality of Health Care Administrative Databases in Canada","author":"Williams","year":"1996"},{"key":"zoi250313r15","unstructured":"Fraser I, Davies SM, Gritz M, et al. AHRQ quality indicators\u2014guide to prevention quality indicators: hospital admission for ambulatory care sensitive conditions. AHRQ Pub No. 02-R0203. Agency for Healthcare Research and Quality. 2001. Accessed March 26, 2025. https:\/\/qualityindicators.ahrq.gov\/Downloads\/Modules\/PQI\/V21\/pqi_guide_rev4.pdf"},{"key":"zoi250313r23","unstructured":"Statistics Canada. Live births and fetal deaths (stillbirths), by place of birth (hospital and non-hospital), Canada, provinces and territories, annual, 2021. Accessed July 26, 2021. https:\/\/www150.statcan.gc.ca\/t1\/tbl1\/en\/tv.action?pid=1310042901"},{"key":"zoi250313r27","unstructured":"Beveridge R, Clarke B, Janes L, et al. Implementation guidelines for the Canadian Emergency Department Triage & Acuity Scale (CTAS) Version: CTAS16.DOC. 1998. Accessed December 2, 2021.http:\/\/ctas-phctas.ca\/wp-content\/uploads\/2018\/05\/ctased16_98.pdf"},{"key":"zoi250313r30","unstructured":"Johns Hopkins School of Public Health. ACG system version 10.0 technical reference guide. 2013. Accessed December 2, 2021. https:\/\/www.hopkinsacg.org\/document\/acg-system-version-10-0-technical-reference-guide\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2833515\/brown_2025_oi_250313_1745610414.76815.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T15:00:33Z","timestamp":1746457233000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2833515"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,5]]},"references-count":46,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.8549","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,5]]}}}