California Emergency Department Utilization in Patients with Sickle Cell Disease: Sociodemographic Predictors.

While patients with sickle cell disease (SCD) visit emergency departments (ED) in rates leading to a significant health system burden, limited comprehensive evaluations of utilization patterns have been published using data connecting visits to patients across facilities.

This study aims to examine sociodemographic predictors of ED utilization in SCD.

This retrospective cohort study employed 2007 data from the California Office of Statewide Health Planning and Development (OSHPD). Data included all inpatient and ED discharges from all non-federal California hospitals; identifiers connected each visit to an individual patient, across all facilities in the state. Primary predictors of interest included age, insurance status and distance to the nearest source of comprehensive SCD care. Additional influential variables included disease severity, urbanicity, gender, race, and ethnicity. Geographic Information Systems software and social networking methods were used to derive a measure of distance from patient residence to the nearest self-identified SCD comprehensive care provider. Multivariate regression techniques evaluated sociodemographic predictors of utilization while also adjusting for confounding variables.

In 2007, 2,920 California SCD patients made 16,364 ED visits. Adults ≥ 21 had higher ED visit rates than children and were more likely to both be in the highest tier of users and visit multiple facilities. Patients living further from the nearest source of a self-identified provider of comprehensive SCD care had higher ED visit rates with a lower likelihood of inpatient admission from the ED. Publicly insured patients had higher ED visit rates and were more likely to be in the highest tier of users than were the privately insured or uninsured.

Age ≥ 21, distance from comprehensive SCD care, and insurance status are significant predictors of ED utilization in SCD. As a routine source of care decreases ED utilization, these findings prompt concern that these factors act as barriers to accessing comprehensive SCD care.

No relevant conflicts of interest to declare.