Department of Radiology & Imaging Sciences, University of Utah School of Medicine, 30 North 1900 East #1A071, Salt Lake City, UT, 84132-2140, USA.
Department of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
Emerg Radiol. 2022 Feb;29(1):125-132. doi: 10.1007/s10140-021-01991-6. Epub 2021 Oct 28.
To examine the trends in CT utilization in the emergency department (ED) for different racial and ethnic groups, factors that may affect utilization, and the effects of increased insurance coverage since passage of the Affordable Care Act in 2010.
Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for the years 2009-2018 were used for the analysis. The NHAMCS is a cross-sectional survey which has random and systematical samples of more than 200,000 visits to over 250 hospital EDs in the USA. Patient demographic characteristics, source of payment/insurance, clinical presentation, and disposition from the ED were recorded. Descriptive statistics and multivariate logistic regression were performed.
Between 2009 and 2018, the rate of uninsured patients in the ED decreased from 18.1% to as low as 9.9%, but this was not associated with a decrease in the disparity in CT utilization between non-Hispanic Black and non-Hispanic White patients. CT use rate increased 38% over the study period. Factors strongly associated with CT utilization include age, source of payment, triage category, disposition from the ED, and residence. After controlling for these factors, non-Hispanic White patients were 21% more likely to undergo CT than non-Hispanic Black patients, though no disparity was seen for Hispanic or Asian/other groups.
Despite increased insurance coverage over the sample period, racial disparities between non-Hispanic Black and non-Hispanic White patients persist in CT utilization, though no disparity was seen for Hispanic or Asian/other patients. The source of this disparity remains unclear and is likely multifactorial.
探讨不同种族和族裔群体在急诊科（ED）中 CT 利用率的趋势，影响利用的因素，以及自 2010 年平价医疗法案通过以来保险覆盖范围增加的影响。
本研究使用了 2009 年至 2018 年全国医院门诊医疗调查（NHAMCS）的数据。NHAMCS 是一项横断面调查，对美国 250 多家医院急诊科的 20 多万次就诊进行了随机和系统抽样。记录了患者的人口统计学特征、支付/保险来源、临床表现和 ED 处置情况。进行了描述性统计和多变量逻辑回归分析。
在 2009 年至 2018 年间，ED 中无保险患者的比例从 18.1%降至低至 9.9%，但这与非西班牙裔黑人和非西班牙裔白人患者之间 CT 使用差异的减少无关。在此期间，CT 使用率增加了 38%。与 CT 利用率密切相关的因素包括年龄、支付来源、分诊类别、ED 处置和居住地。在控制这些因素后，非西班牙裔白人患者进行 CT 的可能性比非西班牙裔黑人患者高 21%，但西班牙裔或亚洲/其他族裔患者则没有差异。
尽管在样本期间保险覆盖范围增加，但非西班牙裔黑人和非西班牙裔白人患者之间在 CT 利用率方面仍存在种族差异，而西班牙裔或亚洲/其他族裔患者则没有差异。这种差异的来源尚不清楚，可能是多因素的。
