Experiment To Decrease Neighborhood Poverty Had Limited Effects On Emergency Department Use

Abstract

Neighborhood environments are increasingly thought to affect emergency department (ED) use. However, because people decide where to live based on a range of factors, it can be challenging to identify the causal impact of living in higher-poverty neighborhoods on increased rates of ED visits. Our study leveraged the Moving to Opportunity for Fair Housing Demonstration Program, a social experiment beginning in 1994 that randomly assigned approximately 4,600 households that received federal housing assistance to different neighborhood conditions. We linked program participants in four states with an average of twelve years of administrative data on ED use (up to twenty-one years after randomization). Contrary to our expectations, we did not find a consistently significant connection between neighborhood poverty and overall ED use during this follow-up period. This result was observed for both adults and people who were children at the time of randomization, as well as for various classifications of ED visits. The findings can help direct future research that seeks to clarify the relationship between neighborhood environments and health care use.

Combined Sewer Overflows and Gastrointestinal Illness in Atlanta, 2002–2013: Evaluating the Impact of Infrastructure Improvements

“…These underlying challenges include increased rates of obesity and chronic disease that may increase severity of GI illness, availability of health insurance, and access to primary care. 35 These factors may affect health-seeking behavior. For example, people living in higher poverty areas may have a higher threshold of illness before they seek care for GI symptoms due to lack of insurance access and cost of care.…”

“…For example, people living in higher poverty areas may have a higher threshold of illness before they seek care for GI symptoms due to lack of insurance access and cost of care. 35 Because of this, it is possible that we are observing disproportionate underreporting from areas with high poverty.…”

Measuring Health Equity in Emergency Care Using Routinely Collected Data: A Systematic Review

“…For example, in a recent study, McCormick et al demonstrate that emergency admissions are primarily due to a higher prevalence of illness in disadvantaged areas, 51 while Pollack et al who analyzed the relationship between neighborhood poverty and ED use in a 21-year randomized social experiment did not find a consistently significant connection between neighborhood poverty and ED use. 56 More studies like these are needed to improve our understanding of the complex interconnectedness between SEDH, health care use, and health care equity.…”