Relationship Between Social Risk Factors and Emergency Department Use: National Health Interview Survey 2016-2018

Evidence shows that social risks are highly prevalent in the patient population that presents to the emergency department (ED) for care; however, understanding the relationship between social risk factors and ED utilization at the population level remains unknown.

We used the National Health Interview Survey from the 2016-2018 sample adult files. The sample included 82,364 individuals, representing a population size of 238,888,238. The primary independent variables included six social risk factors: economic instability; lack of community; educational deficit; food insecurity; social isolation; and inadequate access to care. The outcome included ED use in the prior year. Covariates included age, race/ethnicity, insurance status, obesity, mental health (depression/anxiety), and comorbidities. We ran logistic regression models to test the relationship between the independent and dependent variables adjusting for covariates.

In the study sample, 20% had at least one ED visit in the prior year. In the fully adjusted model, individuals reporting economic instability (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.25-1.42), lack of community (OR 1.10, 95% CI 1.05-1.15), educational deficit (OR 1.12, 95% CI 1.06-1.18), food insecurity (OR 1.77, 95% CI 1.66-1.89), and social isolation (OR 1.32, 95% CI 1.26-1.39) had significantly higher odds of ED use. Inadequate access to care was significantly related to lower odds of ED use (OR 0.75, 95% CI 0.69-0.81).

Social risk factors are significantly associated with higher odds of ED use in the United States adult population. Interventions that integrate social and medical needs are greatly needed, as is understanding the role that preventive medicine may play in reducing avoidable ED visits.