Citation

Arroyo AC, Ewen Wang N, Saynina O, Bhattacharya J, Wise PH. Acad. Emerg. Med. 2012; 19(5): 541-551.

Affiliation

From the Stanford University School of Medicine (ACA), the Division of Emergency Medicine, Department of Surgery (NEW), the Center for Primary Care and Outcomes Research, Department of Medicine (OS, JB, PHW), the Center for Policy Outcomes and Prevention, Department of Pediatrics (OS, PHW), and the Center for Health Policy, Freeman-Spogli Institute for International Studies (PHW), Stanford University School of Medicine, Stanford, CA.

Copyright

(Copyright © 2012, Society for Academic Emergency Medicine, Publisher John Wiley and Sons)

DOI

10.1111/j.1553-2712.2012.01356.x

PMID

22594358

Abstract

Objectives:  This study examined the relationship between insurance status and emergency department (ED) disposition of injured California children. Methods:  Multivariate regression models were built using data obtained from the 2005 through 2009 California Office of Statewide Health Planning and Development (OSHPD) data sets for all ED visits by injured children younger than 19 years of age. Results:  Of 3,519,530 injury-related ED visits, 52% were insured by private, and 36% were insured by public insurance, while 11% of visits were not insured. After adjustment for injury characteristics and demographic variables, publicly insured children had a higher likelihood of admission for mild, moderate, and severe injuries compared to privately insured children (mild injury adjusted odds ratio [AOR] = 1.36, 95% confidence interval [CI] = 1.34 to 1.39; moderate and severe injury AOR = 1.34, 95% CI = 1.28 to 1.41). However, uninsured children were less likely to be admitted for mild, moderate, and severe injuries compared to privately insured children (mild injury AOR = 0.63, 95% CI = 0.61 to 0.66; moderate and severe injury AOR = 0.50, 95% CI = 0.46 to 0.55). While publicly insured children with moderate and severe injuries were as likely as privately insured children to experience an ED death (AOR = 0.91, 95% CI = 0.70 to 1.18), uninsured children with moderate and severe injuries were more likely to die in the ED compared to privately insured children (AOR = 3.11, 95% CI = 2.38 to 4.06). Conclusions:  Privately insured, publicly insured, and uninsured injured children have disparate patterns of ED disposition. Policy and clinical efforts are needed to ensure that all injured children receive equitable emergency care.

Language: en