Health insurance status and utilizing the emergency department for treatment of nonfatal injury

Injuries account for 30% of emergency department (ED) visits and health insurance status may influence the decision to seek care in EDs for some nonfatal injuries. This study examines whether treatment of nonfatal injuries in EDs is associated with health insurance status and whether the association varies by injury type and race/ethnicity, based on analyses of data on medically attended injuries reported in the 2004-2009 National Health Interview Survey. In logistic regression models, adjusted odds of ED treatment (compared to treatment elsewhere) was estimated by health insurance status (privately insured, publicly insured and uninsured), after controlling for age, gender, race/ethnicity, poverty status, education, region of country, MSA status, and nature and cause of injury. Analyses were conducted overall and stratified by race/ethnicity and nature of injury. Among persons with a medically attended injury, the percent who were ED-treated was 46% for the privately insured, 61% for the publically insured, and 63% for the uninsured. Compared with the privately insured, the uninsured (adjusted odds ratio (AOR), 1.7; 95% CI: 1.3-2.2) and publically insured (AOR, 1.6; 95% CI: 1.3-1.9) were more likely to be ED-treated. Among non-Hispanic black persons, the AOR of ED-treatment was 3.9 (95% CI: 1.7-8.7) for the uninsured compared with the privately insured. Uninsured and publically insured persons with medically attended injuries were more likely to use the ED than privately insured persons and the association differed among subgroups. Uninsured and publically insured persons may have fewer treatment options or may be more likely to require urgent care.