Identifying Areas With High Utilizers of Pediatric Health Care Across New York State in Real-World Practice, 2022: Implications for Health Care Delivery.

Objectives. To examine the distribution of high utilizers of pediatric health care across New York State (NYS). Methods. We performed a cross-sectional study using the 2022 NYS inpatient and emergency department data sets for children younger than 18 years. We used a principal component analysis- derived composite adverse utilization index to identify high utilizers (top 5% of the distribution). We used negative binomial models to identify county-level deviation among high utilizer rates. Results. Among 663 006 children, high utilizers accounted for 34.5% of hospital days, 57.3% of admissions, 62.5% of costs, and 5.0% of emergency department visits. High utilizers were more likely to have medical complexity and ambulatory care-sensitive conditions. Bronx and St. Lawrence counties had significantly higher-than-expected rates of high utilizers after adjustment. Conclusions. Pediatric health care burden in NYS is concentrated among a subset of children within identifiable counties. A utilization index offers a pragmatic, reproducible way to target care coordination and community prevention resources, thus informing precision social medicine strategies where need and impact are greatest. (Am J Public Health. 2026;116(11):1810-1818. https://doi.org/10.2105/AJPH.2026.308486).