Frequent Users of US Emergency Departments
Frequent Users of US Emergency Departments
The demographic characteristics and socioeconomic status by frequency of ED utilisation are presented in Table 1. Compared with non-ED users and infrequent ED users, frequent and super-frequent users were more frequently younger in age, female and racial/ethnic minorities, although absolute differences were relatively small. Lower rates of employment, lower poverty–income ratios (more impoverished) and less education achieved were also more frequently reported with higher ED utilisation.
Table 2 summarises the relationship between health conditions and access to healthcare by frequency of ED utilisation. Higher ED utilisation was associated with greater prevalence of chronic conditions such as hypertension (44.6% vs 21.7% (ref=0 ED visits)), diabetes (22.3% vs 6.8% (ref=0 ED visits)), coronary artery disease (19.7% vs 5.0% (ref=0 ED visits)), stroke (11.1% vs 1.8% (ref=0 ED visits)), asthma (22.7% vs 5.9% (ref=0 ED visits)) and emphysema (10.2% vs 1.3% (ref=0 ED visits)). Although frequent and super-frequent ED users had higher rates of reporting never having smoked, they also had higher rates of being lifetime alcohol abstainers. Adults with higher ED utilisation reported ED as their preferred source of healthcare, suggesting a dependence on ED for healthcare. However, 80.3% of super-frequent ED users reported the outpatient clinic as their usual source of healthcare when sick, and 72.7% also reported ≥10 outpatient visits during the past year. Furthermore, higher ED utilisation was also associated with higher outpatient and mental healthcare visits. The percentage of uninsured was similar across the four ED frequency groups; however, a higher proportion of frequent and super-frequent ED users were covered by Medicaid and a lower proportion were covered by private insurance.
Table 3 summarises the adjusted association between patient sociodemographic characteristics and frequent ED users (≥4 ED visits and ≥10 ED visits). Characteristics associated with higher ED use included: non-Hispanic race/ethnicity, Medicaid insurance, lower socioeconomic status, lower self-reported health status and several common chronic diseases. In addition, both patients reporting the ED as their usual source of sick care and those with ≥10 outpatient visits in the past 12 months were more likely to report frequent ED use.
Results
The demographic characteristics and socioeconomic status by frequency of ED utilisation are presented in Table 1. Compared with non-ED users and infrequent ED users, frequent and super-frequent users were more frequently younger in age, female and racial/ethnic minorities, although absolute differences were relatively small. Lower rates of employment, lower poverty–income ratios (more impoverished) and less education achieved were also more frequently reported with higher ED utilisation.
Table 2 summarises the relationship between health conditions and access to healthcare by frequency of ED utilisation. Higher ED utilisation was associated with greater prevalence of chronic conditions such as hypertension (44.6% vs 21.7% (ref=0 ED visits)), diabetes (22.3% vs 6.8% (ref=0 ED visits)), coronary artery disease (19.7% vs 5.0% (ref=0 ED visits)), stroke (11.1% vs 1.8% (ref=0 ED visits)), asthma (22.7% vs 5.9% (ref=0 ED visits)) and emphysema (10.2% vs 1.3% (ref=0 ED visits)). Although frequent and super-frequent ED users had higher rates of reporting never having smoked, they also had higher rates of being lifetime alcohol abstainers. Adults with higher ED utilisation reported ED as their preferred source of healthcare, suggesting a dependence on ED for healthcare. However, 80.3% of super-frequent ED users reported the outpatient clinic as their usual source of healthcare when sick, and 72.7% also reported ≥10 outpatient visits during the past year. Furthermore, higher ED utilisation was also associated with higher outpatient and mental healthcare visits. The percentage of uninsured was similar across the four ED frequency groups; however, a higher proportion of frequent and super-frequent ED users were covered by Medicaid and a lower proportion were covered by private insurance.
Table 3 summarises the adjusted association between patient sociodemographic characteristics and frequent ED users (≥4 ED visits and ≥10 ED visits). Characteristics associated with higher ED use included: non-Hispanic race/ethnicity, Medicaid insurance, lower socioeconomic status, lower self-reported health status and several common chronic diseases. In addition, both patients reporting the ED as their usual source of sick care and those with ≥10 outpatient visits in the past 12 months were more likely to report frequent ED use.
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