Objectives: Asthma exacerbations can cause patients to visit the emergency department (ED) without prior appointments. This study analyzed factors associated with unscheduled ED visits among asthma patients by examining the All of Us Research Program dataset.
Methods: We conducted a retrospective cohort study using the All of Us database (2018-2024). Electronic health records (EHR) were utilized to identify asthma patients based on physician-reported asthma diagnoses. Patients were divided into three groups based on ED visit frequency during the study period: General Asthma Patients (no ED visits), Single ED Visit Asthma Patients (one visit), and Frequent ED Visit Asthma Patients (more than one visit). Python and R were utilized to perform a multinomial logistic regression analysis in order to examine demographic factors, social determinants, healthcare accessibility, neighborhood conditions and comorbidities.
Results: The research included 47, 227 asthma patients from a total participant pool of 409,420 individuals. The study included 33,046 (70.0 %) General Asthma Patients with no ED visit record, 4779 (10.1 %) Single ED Visit Asthma Patients with a single reported visit and 9402 (19.9 %) Frequent ED Visit Asthma Patients with two or more ED visits. Factors significantly associated with frequent ED visits included income less than $10,000/year (OR = 1.42; 95 % CI [1.25-1.61]), Black/African American race (OR = 2.08; 95 % CI [1.61-2.68]), chest pain (OR = 2.31; 95 % CI [2.16-2.48]), hypertension (OR = 1.19; 95 % CI [1.11-1.28]), respiratory tract infections (OR = 1.60; 95 % CI [1.50-1.71]), anxiety (OR = 1.17; 95 % CI [1.08-1.28]), living near abandoned buildings (OR = 1.20; 95 % CI [1.14-1.26]), and perceived daytime neighborhood unsafety (OR = 1.07; 95 % CI [1.02-1.13]). Protective factors included higher income (>$200,000/year, OR = 0.55; 95 % CI [0.42-0.70]), insurance coverage (OR = 0.65; 95 % CI [0.58-0.71]), older age (OR per year = 0.99; 95 % CI [0.99-0.99]), and male sex (OR = 0.86; 95 % CI [0.81-0.92]). Female patients and younger age were associated with increased likelihood of ED visits.
Conclusions: The frequency of unscheduled ED visits for asthma patients was significantly influenced by social determinants which include race, socioeconomic status, neighborhood factors, and specific comorbidities. Understanding these disparities can aid in the improvement of asthma management and the development of targeted interventions to address these critical factors.
Keywords: Acute care utilization; All of us research program; Asthma; Chronic respiratory disease; Comorbidities; Emergency department visits; Epidemiology; Health data analytics; Healthcare access; Healthcare disparities; Healthcare utilization patterns; Logistic regression; Patient outcomes; Population health; Predictive modeling; Risk factors; Social determinants of health; Socioeconomic status; Unscheduled healthcare visits.
Published by Elsevier Inc.