Social Determinants of Emergency Department Visits among Persons Diagnosed with Coronary Heart Disease and Stroke

Abstract

Background: Social determinants of health (SDOH) are associated with a variety of health outcomes, yet their relation to emer­gency department (ED) visits among individu­als with coronary heart disease (CHD) or stroke is unclear.

Objective: We examined whether SDOH were associated with ≥1 ED visit among persons diagnosed with CHD or stroke.

Methods: We performed a cross-sectional analysis of the 2010-2018 National Health Interview Survey, examining ED visits among individuals who self-reported CHD or stroke diagnosis. The outcome was defined as re­porting ≥1 ED visit in the previous 12 months vs none. The SDOH examined were race, employment status, poverty, insurance status, marital status, and educational status.

Results: We included N=14,925 partici­pants with a diagnosis of CHD or stroke. The mean (±SD) age was 68 (±.14) years. After adjusting for age and sex, non-Hispanic Blacks were more likely (adjusted odds ratio [AOR]: 1.29; 95%CI: 1.15-1.44) to report having ≥1 ED visits than Whites. Compared with Whites, Asians had lower odds of having ≥1 ED visit in the previous 12 months (AOR: .63, 95%CI: .49-.82). Those who were unmarried (AOR: 1.21, 95%CI: 1.12 – 1.31), unemployed (AOR: 1.53, 95%CI: 1.36- 1.72) and had a poverty income ratio of <1 (AOR: 1.47, 95%CI: 1.31-1.67) had higher odds of having ≥1 ED visits.

Conclusion: Being Black, unmarried, unem­ployed, and having lower income levels were associated with a higher likelihood of having ≥1 ED visits in the prior 12 months among individuals with a CHD or stroke diagnosis. SDOH should be considered when devel­oping systematic interventions to prevent costly ED visits.

Ethn Dis. 2021;31(1):41-46; doi:10.18865/ed.31.1.41