Gettel Cameron J, Kitchen Courtney, Rothenberg Craig, Song Yuxiao, Koski-Vacirca Ryan, Schaffer Katherine, Janke Alexander T, Mohr Nicholas M, Greenwood-Ericksen Margaret, Venkatesh Arjun K
Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA.
Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, USA.
BMC Health Serv Res. 2025 Jul 24;25(1):975. doi: 10.1186/s12913-025-13161-2.
Older adults in rural geographies may be uniquely vulnerable to difficulty accessing outpatient care, and therefore more reliant on emergency department (ED) care. We compared ED utilization for ambulatory care sensitive conditions (ACSCs) and emergency care sensitive conditions (ECSCs) among rural and urban Medicare beneficiaries.
We conducted a pooled cross-sectional analysis of 2016-2020 Medicare Current Beneficiary Survey data, assessing ED visitation rates for ACSCs and ECSCs. We present ED visit rates per 100 beneficiary-years and estimated logistic regression models to quantify the odds of having any ED visit, any ACSC-related ED visit, or any ECSC-related ED visit in a given year among older adults in rural and urban areas, adjusting for sociodemographic and health characteristics.
Our sample included 70,830 beneficiary-years, with 17,052 (24.1%) being from beneficiaries residing in rural areas. Rural beneficiaries had higher ED visit rates, with a weighted mean (SD) of 59.2 ED visits (14.1) per 100 beneficiary-years across study years, 11.5 (1.3) for ACSC-related, and 20.6 (3.5) for ECSC-related visits, compared to 43.2 (9.2), 7.2 (0.9), and 15.2 (1.9) ED visits, respectively, for urban beneficiary-years. In adjusted models, rural beneficiaries had a 49% higher odds of having an ED visit (OR: 1.49, 95% CI: 1.40-1.59), a 30% higher odds of an ACSC-related ED visit (OR: 1.30, 95% CI: 1.04-1.64), and a 26% higher odds of an ECSC-related ED visit (OR: 1.26, 95% CI: 1.05-1.50) within a given year when compared to urban counterparts.
Rural Medicare beneficiaries consistently showed higher ED utilization for ACSCs and ECSCs compared to urban beneficiaries, highlighting potential disparities in healthcare access and a need for targeted or policy-based interventions.
农村地区的老年人在获得门诊护理方面可能特别容易遇到困难，因此更依赖急诊科护理。我们比较了农村和城市医疗保险受益人中门诊护理敏感疾病（ACSC）和急诊护理敏感疾病（ECSC）的急诊科利用率。
我们对2016 - 2020年医疗保险当前受益人调查数据进行了汇总横断面分析，评估ACSC和ECSC的急诊科就诊率。我们呈现每100受益年的急诊科就诊率，并估计逻辑回归模型，以量化农村和城市地区老年人在给定年份中进行任何急诊科就诊、任何与ACSC相关的急诊科就诊或任何与ECSC相关的急诊科就诊的几率，并对社会人口统计学和健康特征进行调整。
我们的样本包括70,830受益年，其中17,052（24.1%）来自居住在农村地区的受益人。农村受益人有更高的急诊科就诊率，在整个研究年份中，每100受益年的加权平均值（标准差）为59.2次急诊科就诊（14.1），与ACSC相关的为11.5（1.3）次，与ECSC相关的为20.6（3.5）次，而城市受益年分别为43.2（9.2）次、7.2（0.9）次和15.2（1.9）次。在调整模型中，与城市同龄人相比，农村受益人在给定年份中进行急诊科就诊的几率高49%（比值比：1.49，95%置信区间：1.40 - 1.59），与ACSC相关的急诊科就诊几率高30%（比值比：1.30，95%置信区间：1.04 - 1.64），与ECSC相关的急诊科就诊几率高26%（比值比：1.26，95%置信区间：1.05 - 1.50）。
与城市受益人相比，农村医疗保险受益人在ACSC和ECSC方面的急诊科利用率一直较高，这突出了医疗保健可及性方面的潜在差异以及针对性或基于政策的干预措施的必要性。
