Sex differences in frequent ED use among those with multimorbid chronic diseases

Abstract

Objectives To examine the association between multi-morbid chronic disease and frequency of past six months emergency department (ED) visits, by gender, in a community sample of adults from North Florida (N=7,143). Methods Using logistic regression, we estimated associations between multi-morbid chronic disease and frequent ED use, using gender as an effect modifier. Results Multi-morbid chronic disease was associated with frequent ED use overall, with a stronger association among males. Of the 7,143 respondents, 14.4% were frequent ED users, 58.0% were female, and 61.5% were Black Non-Hispanic. Major findings included that females with 3+ chronic diseases were 2.49 (95% CI= 1.7, 3.6) times as likely as females without chronic diseases to report frequent ED use, compared to males with 3+ chronic diseases, who were 4.98 (95% CI= 2.9, 8.6) times as likely as males without chronic disease to report frequent ED use. Conclusions Multi-morbid chronic disease is very strongly associated with frequent ED use among all, but the association is especially strong among males. Future research is needed to further understand this association and its implication for health care.

Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review

“…The mean age of FEDU across studies varied from 38.7 to 51 years, and the 18 to 44 age group was the most prevalent among FEDU . Among all ED users, those in younger age groups were more likely to be FEDU compared with those who were equal to or older than 65 years of age .…”

“…Only one study that included children found that younger age was associated with FEDU . Another study found that the association of age with FEDU differed by gender, with male FEDU being older than male non‐FEDU and female FEDU being younger than female non‐FEDU on average …”

“…We identified four sources of bias within studies related to (1) strategies to deal with confounding variables (eg, selective reporting of results for studies that did not deal with confounding variables), (2) failure to use proper statistical methods, (3) sample size, or (4) valid and reliable measurement of outcomes (eg, response and recall bias for survey‐based results) (Figure ) 21‐31. The risk of bias across studies was low, since we extracted most information from studies with low risk of bias…”

“…One particular study compared the top 108 FEDU with more than 12 visits/year with 108 randomly assigned non‐FEDU (<4 visits/year) . The proportion of FEDU ranged from 3.8% to 16% of the overall ED users, and they accounted for 14.6% to 47% of all ED visits (Appendix ).…”

Risk factors for frequent users of the emergency department among adults aged 55 and older

“…Subsequent research indicates that the elderly and African Americans are among the most frequent ED users. [2,26] With these factors considered, the profile of frequent ED users may vary from hospital to hospital, necessitating creative collaborative nurse educational programs to promote positive patient care outcomes in this deceptively diverse population.…”