COVID-19 case counts and COVID-19 related Emergency Department visits: differences by immigration status, March-December 2020

Annie Ro; Michael Pham Huynh; Tim A Bruckner; Senxi Du; Andrew Young

doi:10.1186/s12889-022-14345-9

COVID-19 case counts and COVID-19 related Emergency Department visits: differences by immigration status, March-December 2020

BMC Public Health. 2022 Oct 26;22(1):1965. doi: 10.1186/s12889-022-14345-9.

Authors

Annie Ro¹, Michael Pham Huynh², Tim A Bruckner³, Senxi Du⁴, Andrew Young⁵

Affiliations

¹ UC Irvine Program in Public Health, Department of Health, Society, and Behavior Anteater Instruction and Research Building (AIRB), Room 2036 653 E. Peltason Road, 92597, Irvine, CA, USA. annie.ro@uci.edu.
² UC Irvine Program in Public Health, Department of Health, Society, and Behavior Anteater Instruction and Research Building (AIRB), Room 2036 653 E. Peltason Road, 92597, Irvine, CA, USA.
³ UC Irvine Program in Public Health, Department of Health, Society, and Behavior Center for Population, Inequality, and Policy, Anteater Instruction and Research Building (AIRB), 653 E. Peltason Road, 92597, Irvine, CA, USA.
⁴ Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁵ Division of Geriatric, Hospital, Palliative and General Internal Medicine, Department of Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA.

Abstract

Background: Undocumented immigrants face barriers to health care access, which may have been exacerbated during the early days of the COVID-19 pandemic. We test whether undocumented immigrants in Los Angeles County accessed COVID-19 related medical care by examining their Emergency Department (ED) patterns through high and low periods of COVID-19 infection. If undocumented immigrants were underutilizing or foregoing health care, we expect null or weaker associations between COVID-19 cases and COVID-19 related ED visits relative to Medi-Cal patients.

Methods: We analyzed all ED visits to the Los Angeles County + University of Southern California (LAC + USC) Medical Center between March - December 2020 (n = 85,387). We conducted logistic regressions with Los Angeles County weekly COVID-19 case counts as our main independent variable and an interaction between case counts and immigration status, stratified by age (over and under 65 years).

Results: We found that undocumented immigrants under 65 years old had a higher odds for a COVID-19 related ED visit compared to Medi-Cal patients and that both undocumented and Medi-Cal patients had higher odds of a COVID-19 related ED visit as COVID-19 cases in Los Angeles County increased. For patients over 65 years, Medi-Cal patients actually had a weaker association between ED visits and county COVID-19 counts; as COVID-19 case counts rose, the odds of a COVID-19 related ED visit increased for the undocumented patients.

Conclusion: While the overall likelihood of undocumented patients having a COVID-19 related ED visit varies compared to Medi-Cal patients - for younger patients, the odds is higher; for older patients, the odds is lower - it does not appear that undocumented patients underutilized the ED during the early COVID-19 pandemic relative to Medi-Cal patients. The ED may be a viable source of contact for this high-risk population for future outreach.

Keywords: COVID-19; Disparities; Emergency department; Immigrants.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
COVID-19* / epidemiology
Emergency Service, Hospital
Emigration and Immigration
Health Services Accessibility
Humans
Pandemics