Immigrant Older Adults Less Likely than Native Born to Use Emergency Departments

The use of emergency departments (EDs) is an important policy issue because their high cost and because inappropriate use of EDs indicates problems in access to care. Despite the public concern over the use of EDs by immigrants, research consistently finds that immigrants are less likely to use EDs than others. But little research focuses on older adults who have the highest levels of potential need for ED services and are also the most likely to have some form of insurance. In particular, the comparatively high rates of family coresidence among immigrants might mediate the use of emergency services by responding more quickly to an illness and facilitating the elder's use of regular outpatient care before it became an emergency. Methods: We used the 2007 California Health Interview Survey, a telephone administered population survey conducted in English, Spanish, and four Asian languages. Among the respondents age 65 and over are1202 Latinos (44% immigrant), 923 Asian Americans (80% immigrant), and 11469 non-Latino whites (7.8% immigrant). We used logistic regressions to model the odds of using an ED one or more times in the past year. Findings: ED use in the past year was significantly lower for older foreign-born Latinos than U.S.-born Latinos (16.9% vs. 28.3%), but was similar for older foreign and U.S.-born Asians (20.6% vs. 17.3%) and non-Latino whites (25.0% vs. 23.8%). Predisposing factors (sex, education) had little predictive value. Enabling factors varied across groups (health insurance type, poverty, rural residence). Several need indicators were common across all three populations (disability, multiple falls, advanced age), while others varied (diabetes, high number of doctor visits). Among all U.S.-born, living without a spouse but with other family increased the use of EDs. The same pattern exists for non-Latino white immigrants, but is reversed for Latino and Asian-American immigrants. Conclusion: After controlling for predisposing, enabling, and need factors, Latino and Asian immigrant elders who lived with family but not a spouse were the least like to use an ED in the previous year. Because of cultural norms and economic need, it is possible that coresiding single elders have family support to obtain earlier outpatient treatment, reducing the need for ED use. Among the U.S.-born coresidence may be driven more by frailty, resulting in higher ED use.