Document Detail


Do California counties with lower socioeconomic levels have less access to emergency department care?
MedLine Citation:
PMID:  20536805     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The study objective was to examine the relationship between number of emergency departments (EDs) per capita in California counties and measures of socioeconomic status, to determine whether individuals living in areas with lower socioeconomic levels have decreased access to emergency care.
METHODS: The authors linked 2005 data from the American Hospital Association (AHA) Annual Survey of Hospitals with the Area Resource Files from the United States Department of Health and Human Services and performed Poisson regression analyses of the association between EDs per capita in individual California counties using the Federal Information Processing Standard (FIPS) county codes and three measures of socioeconomic status: median household income, percentage uninsured, and years of education for individuals over 25 years of age. Multivariate analyses using Poisson regression were also performed to determine if any of these measures of socioeconomic status were independently associated with access to EDs.
RESULTS: Median household income is inversely related to the number of EDs per capita (rate ratio = 0.83; 95% confidence interval [CI] = 0.71 to 0.96). Controlling for income in the multivariate analysis demonstrates that there are more EDs per 100,000 population in FIPS codes with more insured residents when compared with areas having less insured residents with the same levels of household income. Similarly, FIPS codes whose residents have more education have more EDs per 100,000 compared with areas with the same income level whose residents have less education.
CONCLUSIONS: Counties whose residents are poorer have more EDs per 100,000 residents than those with higher median household incomes. However, for the same income level, counties with more insured and more highly educated residents have a greater number of EDs per capita than those with less insured and less educated residents. These findings warrant in-depth studies on disparities in access to care as they relate to socioeconomic status.
Authors:
Deepa Ravikumar; Renee Hsia
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Academic emergency medicine : official journal of the Society for Academic Emergency Medicine     Volume:  17     ISSN:  1553-2712     ISO Abbreviation:  Acad Emerg Med     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-06-11     Completed Date:  2010-09-28     Revised Date:  2011-08-01    
Medline Journal Info:
Nlm Unique ID:  9418450     Medline TA:  Acad Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  508-13     Citation Subset:  IM    
Affiliation:
Department of Emergency Medicine, University of California, San Francisco, CA, USA. deepa.ravikumar@ucsf.edu
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MeSH Terms
Descriptor/Qualifier:
California
Educational Status
Emergency Service, Hospital / utilization*
Female
Health Services Accessibility*
Humans
Income / statistics & numerical data
Male
Medically Uninsured / statistics & numerical data
Poisson Distribution
Retrospective Studies
Social Class*
Grant Support
ID/Acronym/Agency:
KL2 RR024130/RR/NCRR NIH HHS; KL2 RR024130-05/RR/NCRR NIH HHS; L60 MD002903-02/MD/NCMHD NIH HHS
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