Wilder Marcee, Holaday Louisa, Maroko Andrew, Lopez Christopher, Souffront Kimberly, Horowitz Carol, Richardson Lynne D
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Am Coll Emerg Physicians Open. 2025 May 30;6(4):100183. doi: 10.1016/j.acepjo.2025.100183. eCollection 2025 Aug.
Emergency department (ED) visits that could be managed in primary care settings contribute to inefficiencies and increased health care costs. We examined the relationship between area-level social vulnerability and potentially avoidable ED encounters, controlling for individual factors among insured patients.
We conducted a retrospective cohort study using the Institute for Health Equity Research Multi-Payer Claims Database, analyzing ED visits from 26,727,123 patients between January 2022 and December 2022. The 3-digit ZIP code Social Vulnerability Index (SVI), a composite measure of community risk, was the primary predictor. ED visits were classified as either primary care treatable (PCT) or ED care needed using the Minnesota algorithm. We applied generalized estimating equations to assess the relationship between the SVI and PCT ED visits, adjusting for individual age, sex, race/ethnicity, insurance type, and comorbidity.
Higher SVI scores were significantly associated with an increased likelihood of PCT ED visits (adjusted odds ratio [aOR], 1.77; 95% CI, 1.71-1.83), independent of individual factors. Among the SVI themes, housing and transportation showed the strongest association (aOR, 2.67; 95% CI, 2.55-2.81). Black (aOR, 1.15; 95% CI, 1.12-1.18) and Hispanic patients (aOR, 1.17; 95% CI, 1.15-1.19), as well as Medicaid recipients (aOR, 1.29; 95% CI, 1.28-1.30), also had greater odds of PCT visits.
Area-level social vulnerability, particularly related to housing and transportation, is associated with PCT ED visits. Targeted interventions to enhance primary care access in vulnerable communities may help reduce nonemergent ED utilization and associated costs.
在初级保健机构可处理的急诊科就诊会导致效率低下并增加医疗成本。我们研究了地区层面的社会脆弱性与潜在可避免的急诊科就诊之间的关系，并控制了参保患者的个体因素。
我们使用健康公平研究所多支付方索赔数据库进行了一项回顾性队列研究，分析了2022年1月至2022年12月期间26,727,123名患者的急诊科就诊情况。3位数邮政编码社会脆弱性指数（SVI）是社区风险的综合衡量指标，为主要预测因素。使用明尼苏达算法将急诊科就诊分为初级保健可治疗（PCT）或需要急诊科护理两类。我们应用广义估计方程来评估SVI与PCT急诊科就诊之间的关系，并对个体年龄、性别、种族/民族、保险类型和合并症进行了调整。
较高的SVI分数与PCT急诊科就诊可能性增加显著相关（调整后的优势比[aOR]为1.77；95%置信区间[CI]为1.71 - 1.83），与个体因素无关。在SVI主题中，住房和交通显示出最强的关联（aOR为2.67；95% CI为2.55 - 2.81）。黑人患者（aOR为1.15；95% CI为1.12 - 1.18）和西班牙裔患者（aOR为1.17；95% CI为1.15 - 1.19）以及医疗补助接受者（aOR为1.29；95% CI为1.28 - 1.30）的PCT就诊几率也更高。
地区层面的社会脆弱性，特别是与住房和交通相关的，与PCT急诊科就诊有关。在脆弱社区加强初级保健服务的针对性干预措施可能有助于减少非紧急情况下的急诊科利用及相关成本。
