Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Suicide Life Threat Behav. 2023 Aug;53(4):702-712. doi: 10.1111/sltb.12975. Epub 2023 Jul 11.
To explore demographic predictors of Emergency Department (ED) utilization among youth with a history of suicidality (i.e., ideation or behaviors).
Electronic health records were extracted from 2017 to 2021 for 3094 8-22 year-old patients with a history of suicidality at an urban academic medical center ED in the Mid-Atlantic. Logistic regression analyses were used to assess for demographic predictors of ED utilization frequency, timing of subsequent visits, and reasons for subsequent visits over a 24-month follow-up period.
Black race (OR = 1.45, 95% CI = 1.11-1.92), Female sex (OR = 1.59, 95% CI = 1.26-2.03), and having Medicaid insurance (OR = 1.71, 95% CI = 1.37-2.14) were associated with increased utilization, while being under 18 was associated with lower utilization (<12: OR = 0.38, 95% CI = 0.26-0.56; 12-18: OR = 0.47, 95% CI = 0.35-0.63). These demographics were also associated with ED readmission within 90 days, while being under 18 was associated with a lower odds of readmission.
Among patients with a history of suicidality, those who identify as Black, young adults, patients with Medicaid, and female patients were more likely to be frequent utilizers of the ED within the 2 years following their initial visit. This pattern may suggest inadequate health care access for these groups, and a need to develop better care coordination with an intersectional focus to facilitate utilization of other health services.
探讨有自杀史（即意念或行为）的青年患者到急诊科就诊的人口统计学预测因素。
从 2017 年至 2021 年，从大西洋中部一家城市学术医疗中心的急诊科提取了 3094 名 8-22 岁有自杀史的患者的电子健康记录。使用逻辑回归分析评估 24 个月随访期间，人口统计学预测因素与急诊科就诊频率、后续就诊时间以及后续就诊原因之间的关系。
黑种人（OR=1.45，95%CI=1.11-1.92）、女性（OR=1.59，95%CI=1.26-2.03）和拥有医疗补助保险（OR=1.71，95%CI=1.37-2.14）与就诊频率增加相关，而年龄在 18 岁以下与就诊频率降低相关（<12 岁：OR=0.38，95%CI=0.26-0.56；12-18 岁：OR=0.47，95%CI=0.35-0.63）。这些人口统计学因素也与 90 天内急诊科再次入院相关，而年龄在 18 岁以下与再次入院的可能性较低相关。
在有自杀史的患者中，那些自认为是黑人、年轻成年人、拥有医疗补助保险的患者和女性患者在首次就诊后 2 年内更有可能频繁到急诊科就诊。这种模式可能表明这些群体的医疗保健获取不足，需要以交叉为重点制定更好的护理协调，以促进其他卫生服务的利用。
