Director, Impact Evaluation and Grants Management, Department of Community Health, Atrium Health, Charlotte, North Carolina.
System director, CommonSpirit Population Health, CommonSpirit Health, San Francisco, California.
N C Med J. 2022 Jan-Feb;83(1):48-57. doi: 10.18043/ncm.83.1.48.
Residential segregation is a spatial manifestation of structural racism. Racial disparities in emergency department (ED) utilization mirror social inequity in the larger community. We evaluated associations between residential segregation and ED utilization in a community with known disparities and geographically concentrated social and health risk. Cross-sectional data were collected from electronic medical records of 101 060 adult ED patients living in Mecklenburg County, North Carolina in 2017. Community context was measured as residential segregation using the dissimilarity index, categorized into quintiles (Q1-Q5) using 2013-2017 American Community Survey estimates, and residency in a public health priority area (PHPA). The outcome was measured as total ED visits during the study period. Associations between community context and ED utilization were modeled using Anderson's behavioral model of health service utilization, and estimated using negative binomial regression, including interaction terms by race. Compared to areas with the lowest proportions of Black residents (Q1), living in Q4 was associated with higher rates of ED utilization among Black/Other (AME = 0.11) and White (AME = 0.23) patients, while associations with living in Q5 were approximately equivalent (AME = 0.12). PHPA residency was associated with higher rates of ED utilization among Black/Other (AME = 0.10) and White patients (AME = 0.22). Associations should not be interpreted as causal, or be generalized to the larger community without ED utilization. Health system leakage is possible but limited. Residential segregation is associated with higher rates of ED utilization, as are PHPA residency and other individual-level determinants.
居住隔离是结构性种族主义的空间表现。急诊部门（ED）利用的种族差异反映了更大社区中社会不平等的情况。我们评估了在一个具有已知差异和集中的社会和健康风险的社区中，居住隔离与 ED 利用之间的关联。2017 年，从北卡罗来纳州梅克伦堡县 101060 名成年 ED 患者的电子病历中收集了横断面数据。使用不相似指数来衡量社区环境作为居住隔离，根据 2013-2017 年美国社区调查估计，将其分为五个五分位数（Q1-Q5），并居住在公共卫生重点区域（PHPA）。结果是研究期间的总 ED 就诊次数。使用卫生服务利用行为模型对社区环境与 ED 利用之间的关联进行建模，并使用负二项回归进行估计，包括按种族的交互项。与黑人居民比例最低的地区（Q1）相比，生活在 Q4 与黑人/其他种族（AME = 0.11）和白人（AME = 0.23）患者的 ED 利用率较高相关，而生活在 Q5 的关联则大致相当（AME = 0.12）。PHPA 居住与黑人/其他种族（AME = 0.10）和白人患者（AME = 0.22）的 ED 利用率较高相关。关联不应被解释为因果关系，或未经 ED 利用而推广到更大的社区。卫生系统渗漏是可能的，但有限的。居住隔离与 ED 利用率较高有关，PHPA 居住和其他个体水平决定因素也是如此。
