Racial/Ethnic differences in emergency department triage assignment among visits for substance use

Area of Science:

• Public Health
• Health Services Research
• Health Equity

Background:

• The United States faces a public health crisis due to the opioid and substance use disorder (SUD) epidemic.
• Stigma from healthcare workers and racial inequities in emergency departments (EDs) act as barriers to SUD treatment.
• Racial disparities in ED wait times and service provision for SUD patients are documented.

Purpose of the Study:

• To investigate racial and ethnic disparities in the severity of triage assignments for patients presenting to EDs with substance use disorder.
• To analyze differences in ED triage levels based on race and ethnicity among individuals with SUD.

Main Methods:

• A retrospective analysis of pooled data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2016-2020.
• Utilized multivariable logistic regression to assess differences in triage level by race/ethnicity among SUD patients.
• Controlled for covariates including age, sex, and mode of arrival (e.g., ambulance).

Main Results:

• The study included 788 ED visits for SUD. Non-Hispanic White patients comprised 56.0%, non-Hispanic Black patients 28.6%, and Hispanic patients 12.9%.
• Visits by Black patients with SUD had 53% lower odds of being assigned an immediate/emergent triage level compared to White patients (OR=0.47, p=0.025).

Conclusions:

• Black patients with SUD were significantly less likely to receive emergent triage in the ED compared to White patients, even after adjusting for confounding factors.
• These findings indicate a potential for dual stigma—based on race and SUD status—affecting emergency care.
• The results highlight critical areas for improving equitable care delivery for individuals with substance use disorder in emergency settings.