Understanding the association between frequent emergency department use and jail incarceration: A cross‐sectional analysis

Abstract

Background Frequent emergency department (ED) use and incarceration can be driven by underlying structural factors and social needs. If frequent ED users are at increased risk for incarceration, ED‐based interventions could be developed to mitigate this risk. The objective of this study was to determine whether frequent ED use is associated with incarceration. Methods We conducted a retrospective cross‐sectional study of 46,752 individuals in San Francisco Department of Public Health's interagency, integrated Coordinated Care Management System (CCMS) during fiscal year 2018–2019. The primary exposure was frequency of ED visits, and the primary outcome was presence of any county jail incarceration during the study period. We performed descriptive and multivariable analysis to determine the association between the frequency of ED use and jail encounters. Results The percentage of those with at least one episode of incarceration during the study period increased with increasing ED visit frequency. Unadjusted odds of incarceration increased with ED use frequency: odds ratio (OR) = 2.14 (95% confidence interval [CI] = 1.94–2.35) for infrequent use, OR = 4.98 (95% CI = 4.43–5.60) for those with frequent ED use, and OR = 12.33 (95% CI = 9.59–15.86) for those with super‐frequent ED use. After adjustment for observable confounders, the odds of incarceration for those with super‐frequent ED use remained elevated at 2.57 (95% CI = 1.94–3.41). Of those with super‐frequent ED use and at least one jail encounter, 18% were seen in an ED within 30 days after release from jail and 25% were seen in an ED within 30 days prior to arrest. Conclusions Frequent ED use is independently associated with incarceration. The ED may be a site for intervention to prevent incarceration among frequent ED users by addressing unmet social needs.

Emergency care of prisoners in Australia

“…Emergency physicians need to be specifically attuned to this group of patients as a recent study confirmed frequent ED use is independently associated with incarceration. This is not surprising as the social determinants of health and incarceration are similar 1 . The article by Wu et al .…”

“…This is not surprising as the social determinants of health and incarceration are similar. 1 The article by Wu et al in this journal 2 is a timely reminder of the need for good care for this population and comes on the background of a number of deaths in custody. Systemic improvements will not be possible without first addressing the need for improved access to patients in non-health settings, effective systems, a level of tailored and respectful care, and a professionalised workforce.…”

Identifying incarceration status in the electronic health record using large language models in emergency department settings

“…Particularly, individuals with super-frequent ED usage, defined as 18 or more visits per year, are found to have 12.3 times higher odds of subsequent incarceration. In addition, those who were incarcerated saw a significantly increased likelihood of visiting the ED within 30 days prior to incarceration or 30 days following jail exit [13]. These interactions with the health system serve as opportunities for health system level interventions to address this social risk, such as engagement in interventions to prevent incarceration (initiation of medications for opioid use disorder, violence intervention programs) or prevent poor outcomes after release (engagement into primary care programs) [14][15][16][17].…”

Care and Complexity in Emergency Housing: an Examination of the COVID-19 Shelter-in-Place (SIP) Hotel Program to House People Experiencing Homelessness in San Francisco

“…1, overt and structural racism are significant factors that directly and indirectly impact higher rates of incarceration, trauma, and lost economic opportunities [8][9][10][11]. Further, high-cost healthcare utilization is independently associated with incarceration [12]. As such, the social and historical impact of structural racism in SF affects the health and wellness of PEH and directly impacts a Black individual's experience of homelessness and their relationship with public services, including housing and healthcare.…”