Emergency Department Utilization by Race, Ethnicity, Language, and Medicaid Status

Area of Science:

• Health Services Research
• Health Disparities
• Epidemiology

Background:

• Emergency department (ED) utilization is influenced by patient demographics, including age, sex, race, ethnicity, language preference, and insurance type.
• Previous research often aggregated data, potentially obscuring specific disparities in ED use among different racial and ethnic subgroups, particularly those with non-English language preferences (NELP).

Purpose of the Study:

• To disaggregate the associations between race, ethnicity, language preference, and Medicaid coverage with ED utilization.
• To identify specific patterns of ED use across diverse racial, ethnic, and language preference groups within a large health plan membership.

Main Methods:

• Cross-sectional analysis of electronic health record data from 2,047,105 adult members (aged 25-85) of a Northern California health plan (2018-2019).
• Tabulation of ED visit prevalence by race, ethnicity, age group, and language preference.
• Modified log-Poisson regression adjusted for demographic factors and Medicaid status to assess differences in ED utilization.

Main Results:

• Black and Hispanic adults showed higher ED visit likelihood compared to White adults; Chinese, Vietnamese, and South Asian adults showed lower likelihood.
• Non-English language preference (NELP) was associated with lower ED use in younger adults (25-64) overall, but this varied by ethnicity, with some groups showing higher ED use.
• Medicaid-covered adults aged 25-64 were twice as likely, and those aged 65-85 were 50% more likely, to have an ED visit compared to non-Medicaid covered individuals.

Conclusions:

• Significant variations in ED use exist across racial, ethnic, and language subgroups, underscoring the importance of disaggregated data analysis.
• Medicaid-covered adults, especially those under 65, demonstrated a higher prevalence of ED use across most racial and ethnic groups.
• Further research into social, personal, and policy factors driving ED use in diverse populations is crucial for developing effective, population-specific health interventions.