Determinants of emergency department use: are race and ethnicity important?

Ann Emerg Med. 1996 Dec;28(6):677-82. doi: 10.1016/s0196-0644(96)70093-8.


Study objective: To determine whether race/ethnicity is an important determinant of emergency department use.

Methods: We conducted a cross-sectional survey in a public ED to determine self-reported ED visits over the preceding 3 months. The study group comprised consecutive ambulatory patients (N = 1,049) with nonemergency medical problems.

Results: Blacks, whites, and Hispanics were equally likely to report one or more visits to an ED in the 3 months before study enrollment. Blacks were the most likely to report two or more ED visits in the preceding 3 months (19.0%), followed by whites (13.5%) and Hispanics (11.4%) (P = .01; unadjusted odds ratio, 1.82 for blacks versus Hispanics). In multivariate analysis, older age (P < .001), health insurance coverage (P < .001), regular source of care (P < .001), and difficulty obtaining transportation to a physician's office (P = .011) were positively associated with two or more previous ED visits. After adjustment for these variables, race/ethnicity was not significantly associated with ED use (P = .23; adjusted odds ratio for blacks versus Hispanics, 1.48 [95% confidence interval, .95 to 2.30]).

Conclusion: Race/ethnicity was not an important determinant of ED use after adjustment for age, health insurance coverage, regular source of care, and barriers to health care. Population-based studies of ED use should be conducted to further evaluate whether racial/ethnic differences in ED use exist that are not explained by differences in demographics, health, socioeconomic status, access to care, or other determinants of ED use.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Black or African American
  • California
  • Confidence Intervals
  • Cross-Sectional Studies
  • Emergency Service, Hospital / statistics & numerical data*
  • Ethnicity*
  • Female
  • Health Services Accessibility
  • Hispanic or Latino
  • Hospitals, University
  • Humans
  • Insurance, Health
  • Male
  • Middle Aged
  • Odds Ratio
  • Transportation
  • White People