Racial disparities in emergency department utilization among patients with newly diagnosed depression

Frank Müller; Akhilesh Munagala; Judith E Arnetz; Eric D Achtyes; Omayma Alshaarawy; Harland T Holman

doi:10.1016/j.genhosppsych.2023.10.018

Racial disparities in emergency department utilization among patients with newly diagnosed depression

Gen Hosp Psychiatry. 2023 Nov-Dec:85:163-170. doi: 10.1016/j.genhosppsych.2023.10.018. Epub 2023 Oct 31.

Authors

Frank Müller¹, Akhilesh Munagala², Judith E Arnetz³, Eric D Achtyes⁴, Omayma Alshaarawy⁵, Harland T Holman⁶

Affiliations

¹ Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA; Corewell Health Family Medicine Residency Clinic, Grand Rapids, MI, USA; Department of General Practice, University Medical Center Göttingen, Göttingen, Germany. Electronic address: muell313@msu.edu.
² Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA. Electronic address: munagal1@msu.edu.
³ Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA. Electronic address: arnetzju@msu.edu.
⁴ Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA. Electronic address: eric.achtyes@WMed.edu.
⁵ Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA. Electronic address: alshaara@msu.edu.
⁶ Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA; Corewell Health Family Medicine Residency Clinic, Grand Rapids, MI, USA. Electronic address: holmanha@msu.edu.

PMID: 37926052
DOI: 10.1016/j.genhosppsych.2023.10.018

Abstract

Objective: To test the hypothesis that racial and ethnic minorities have increased emergency department visit rates, despite being established with a primary care provider.

Methods: In this retrospective cohort study, ED visits without hospital admission in a 12-month period among patients with a new primary care provider-issued diagnosis of depression were assessed. Electronic medical record (EMR) data was obtained from 47 family medicine clinics in a large Michigan-based healthcare system. General linear regression models with Poisson distribution were used to predict frequency of ED visits.

Results: A total of 4159 patients were included in the analyses. In multivariable analyses, Black / African American race was associated with an additional 0.90 (95% CI 0.64, 1.16) ED visits and American Indian or Alaska Native race was associated with an additional 1.39 (95% CI 0.92, 1.87) ED visits compared to White or Caucasians (null value 0). These risks were only exceeded by patients who received a prescription for a typical antipsychotic drug agent.

Conclusion: Despite being established patients at primary care providers and having follow-up encounters, Black / African American and American Indian or Alaska Native patients with depression were considerably more likely to seek ED treatment compared to White/Caucasian patients with depression.

Keywords: Affective disorder; Black /African Americans; Health disparities; Health equity; Mental health; Mood disorder.

MeSH terms

American Indian or Alaska Native
Black or African American
Depression* / epidemiology
Emergency Service, Hospital
Healthcare Disparities*
Humans
Patient Acceptance of Health Care* / statistics & numerical data
Racial Groups
Retrospective Studies
United States
White