Predictors of emergency room use: Are they gender-specific?

Reducing the burden of overcrowding and unnecessary use of emergency room (ER) continues to be a priority in lowering health care spending. Higher ER use has been reported among vulnerable populations including drug users, individuals who have just been released from jail or prison, and those with no stable housing. This study examines whether factors that affecting emergency room use are gender specific.

Data were collected from 1,259 clients who came for HIV and STD screening in an outpatient care center in Long Beach, California. Each client was interviewed twice using the Risk Behavior Assessment (RBA) to collect all independent variables and the Risk Behavior Follow-Up Assessment (RBFA) to collect the outcome variable with at least a three-month interval in between interviews.

Of 1259 respondents, 24.7% (311/1259) were female and 30.4% (383/1259) have ever been treated in the ER or in a hospital as a patient in the last 6 months. In bivariate analysis, ER use was significantly associated with gender, living arrangement, education, income, marital status, sexual orientation, history of incarceration, drug use, sexual trading practice, and having been in a drug treatment program. In the logistic regression among male sub-sample, of those 10 potential predictors, only three predictors were significant. ER use were significantly predicted by income (OR = 1.72, CL = 1.04 – 2.85), having been in a drug treatment program (OR = 2.05, CL = 1.34 – 3.13), and history of incarceration (OR = 1.67, CL = 1.03 – 2.73). Among the female sub-sample, only injection drug use was a significant predictor of ER use (OR = 2.66, CL = 1.26 – 5.59).

Predictors of ER use were gender-specific. Among male respondents, exposure to a drug treatment program and a history of incarceration were significant, while among female respondents, injection drug use was the only significant predictor of ER use. The findings suggest the importance of access to medical care among men who have been in drug treatment or released from incarceration. On the other hand, access to medical care is very crucial among drug injecting women. Targeted rehabilitative programs could help prevent unnecessary ER use and reduce the economic burden to society. Further studies will need to include detail information on reasons for ER use. This information is particularly useful to separate cases that are merely medical and not violence/ assault or drug-related incidents.