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Published on: June 2, 2014
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Rural disparities in emergency department utilization for migraine care
Christian Rhudy1, Aric Schadler2, Mark Huffmyer1
1Specialty Pharmacy and Infusion Services, University of Kentucky Healthcare, Lexington, Kentucky, USA.
Headache
|December 13, 2023
Summary
Rural populations, especially in Appalachia, show higher emergency department (ED) use for migraine and are more likely to receive opioid treatment. Targeted interventions are needed to improve outpatient care access for these groups.
Area of Science:
- Public Health
- Epidemiology
- Health Services Research
Background:
- Migraine incurs significant healthcare costs in the US, with over 4 million annual emergency department (ED) visits.
- Rural populations often face health disparities due to factors like socioeconomic status and limited healthcare access.
- Previous research indicates rural disparities in other health conditions, prompting investigation into migraine care.
Purpose of the Study:
- To compare emergency department (ED) utilization for migraine between rural and nonrural populations.
- To evaluate differences in the quality of migraine care received in EDs based on geographic residence.
- To identify potential disparities in migraine management for rural versus nonrural patients.
Main Methods:
- A cross-sectional study analyzing 2019 emergency department (ED) data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Emergency Department Sample (NEDS).
- Included ED encounters with a primary diagnosis code for migraine (G43.xx).
- Compared crude and age-adjusted ED utilization rates, mean ED charges, and treatment proportions (medication, imaging, nerve blocks) between rural and nonrural patients.
Main Results:
- Rural patients had significantly higher crude and age-adjusted ED utilization rates for migraine compared to nonrural patients.
- Opioid utilization was substantially higher in ED encounters for migraine among rural patients (14.6%) versus nonrural patients (8%).
- A Kentucky sub-analysis revealed higher ED utilization and opioid use for migraine in the Appalachian region compared to non-Appalachian and national rural groups.
Conclusions:
- Rural populations, particularly in Appalachia, experience disproportionately higher emergency department (ED) utilization for migraine.
- Migraine management in rural EDs may be suboptimal, with a greater reliance on opioid analgesia.
- Development of multimodal healthcare interventions is crucial to enhance outpatient migraine care access and address risk factors in rural populations.
