Are unmet health related social needs associated with emergency department utilization among Medicare beneficiaries?

BACKGROUND

Health-related social needs (HRSN) are increasingly recognized as important factors influencing healthcare outcomes and utilization. This study examined the association between unmet HRSNs and emergency department (ED) utilization among Medicare beneficiaries.

METHODS

We conducted a retrospective, survey-weighted cohort analysis of the 2015-2016 Medicare Current Beneficiary Survey (MCBS) linked with Medicare fee-for-service claims. The study included beneficiaries aged ≥ 65 years enrolled in fee-for-service Medicare who completed the MCBS. The primary predictor was having ≥ 1 unmet HRSN (food insecurity, delaying care due to cost, or difficulty accessing medical care). Primary outcomes included an index ED visit (1 ED visit) and any ED revisit within one year (≥ 2 ED visits); hospital admission from these ED visits was a secondary outcome. We fit multivariable logistic regression models adjusted for demographic, socioeconomic, and clinical factors. Interactions were tested using adjusted Wald tests.

RESULTS

Among 16,990 beneficiaries, 6.2% (n = 1,046) reported one or more unmet HRSNs. Within one year of completion of the survey, 27.7% (n = 4,702) had an 1 ED visit, with 9.03% of all beneficiaries (n = 1,535) requiring admission to the hospital. In adjusted analyses, beneficiaries with unmet HRSN had significantly higher odds of ≥ 2 ED visits (OR 1.47, 95% CI 1.12-1.91) compared to those without unmet HRSNs, but not for index ED visit. The oldest age category (85 + years) showed significantly increased odds of both index ED visits and revisits. Unmet HRSN were not significantly associated with risk of subsequent hospital admission for both index ED visit and ED revisit.

CONCLUSION

Self-reported unmet HRSNs were associated with significantly increased odds of ≥ 2 ED visits but not an 1 ED visit within one year of the MCBS survey. These findings highlight the importance of improved and standardized data collection of HRSNs to understand the impacts on ED utilization. Oldest age patients had increased odds of index ED visits and revisits. Further investigation should focus on strategies to reduce ED recidivism in vulnerable older populations.