Journal of General Internal Medicine

, Volume 25, Issue 7, pp 663–669 | Cite as

Dependence on Emergency Care among Young Adults in the United States

  • Robert J. FortunaEmail author
  • Brett W. Robbins
  • Nandini Mani
  • Jill S. Halterman
Original Article



Young adults have a high prevalence of many preventable diseases and frequently lack a usual source of ambulatory care, yet little is known about their use of the emergency department.


To characterize care provided to young adults in the emergency department.


Cross-sectional analysis of visits from young adults age 20 to 29 presenting to emergency departments (N = 17,048) and outpatient departments (N = 14,443) in the National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey.


Visits to the emergency department compared to ambulatory offices.


Emergency department care accounts for 21.6% of all health care visits from young adults, more than children/adolescents (12.6%; P < 0.001) or patients 30 years and over (8.3%; P < 0.001). Visits from young adults were considerably more likely to occur in the emergency department for both injury-related and non-injury-related reasons compared to children/adolescents (P < 0.001) or older adults (P < 0.001). Visits from black young adults were more likely than whites to occur in the emergency department (36.2% vs.19.2%; P < 0.001) rather than outpatient offices. The proportion of care delivered to black young adults in the emergency department increased between 1996 and 2006 (25.9% to 38.5%; P = 0.001 for trend). In 2006, nearly half (48.5%) of all health care provided to young black men was delivered through emergency departments. The urgency of young adult emergency visits was less than other age groups and few (4.7%) resulted in hospital admission.


A considerable amount of care provided to young adults is delivered through emergency departments. Trends suggest that young adults are increasingly relying on emergency departments for health care, while being seen for less urgent indications.

Key words

emergency care ambulatory care young adults 



Dr. Fortuna received support from the Center for Primary Care, University of Rochester. The authors thank the Center for Primary Care for support of this project.

Conflict of Interest

None disclosed.


  1. 1.
    Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2007. Atlanta: U.S.Department of Health and Human Services; 2008.Google Scholar
  2. 2.
    Park MJ, Paul MT, Adams SH, Brindis CD, Irwin CE Jr. The health status of young adults in the United States. J Adolesc Health. 2006;39:305–17.CrossRefPubMedGoogle Scholar
  3. 3.
    Substance Abuse and Mental Health Services Administration. (2008). Results from the 2007 National survey on drug use and health: National findings. Rockville, MD, Office of Applied Studies, NSDUH Series H-34, DHHS Publication No. SMA 08-4343.Google Scholar
  4. 4.
    Callahan ST, Cooper WO. Uninsurance and health care access among young adults in the United States. Pediatrics. 2005;116:88–95.CrossRefPubMedGoogle Scholar
  5. 5.
    Fortuna RJ, Robbins BW, Halterman JS. Ambulatory care among young adults in the United States. Ann Intern Med. 2009;151:379–85.PubMedGoogle Scholar
  6. 6.
    Kriss JL, Collins SR, Mahato B, Gould E, Schoen C. Rite of passage? Why young adults become uninsured and how new policies can help, update. The Commonwealth Fund. 38, 1-24. New York, NY; 2008.Google Scholar
  7. 7.
    Park MJ, Brindis CD, Chang F, Irwin CE Jr. A midcourse review of the healthy people 2010: 21 critical health objectives for adolescents and young adults. J Adolesc Health. 2008;42:329–34.CrossRefPubMedGoogle Scholar
  8. 8.
    US Department of Health and Human Services. Healthy People 2010: Understanding and improving health. Washington, DC: U.S. Government Printing Office; 2000.Google Scholar
  9. 9.
    Committee on the Future of Emergency Care in the United States Health System IoM. Hospital-based emergency care: At the breaking point. Washington: The National Academies Press; 2007.Google Scholar
  10. 10.
    Kellermann AL. Crisis in the emergency department. N Engl J Med. 2006;355:1300–3.CrossRefPubMedGoogle Scholar
  11. 11.
    National Center for Health Statistics. NCHS public-use data files and documentation: National Hospital Ambulatory Medical Care Survey (NHAMCS). Available at: Last Accessed 2-4-2010.
  12. 12.
    National Center for Health Statistics. NCHS public-use data files and documentation: National Ambulatory Medical Care Survey (NAMCS). Available at: Last Accessed 2-4-2010.
  13. 13.
    Rochester Community-Wide Clinical Guidelines Steering Committee. Preventive care of adults ages 19 years and older. Rochester Community Practice Guideline. Monroe County Medical Society: Rochester; 2007.Google Scholar
  14. 14.
    Hostetler MA, Auinger P, Szilagyi PG. Parenteral analgesic and sedative use among ED patients in the United States: combined results from the National Hospital Ambulatory Medical Care Survey (NHAMCS) 1992-1997. Am J Emerg Med. 2002;20:83–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Ziv A, Boulet JR, Slap GB. Emergency department utilization by adolescents in the United States. Pediatrics. 1998;101:987–94.CrossRefPubMedGoogle Scholar
  16. 16.
    Pitts SR, Niska RW, Xu J, Burt CW. National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. Natl Health Stat Report 2008;1-38.Google Scholar
  17. 17.
    National Center for Health Statistics Institutional Review Board. Protocol #2003-05 National Ambulatory Medical Care Survey., 2-12-2003. Department of Health and Human Services, National Center for Health Statistics. 11-28-2007.
  18. 18.
    Substance Abuse and Mental Health Services Administration, Office of Applied Studies. The NSDUH Report: Treatment for Past Year Depression among Adults. 1-3-2008. Rockville, MD.Google Scholar
  19. 19.
    Callahan ST, Hickson GB, Cooper WO. Health care access of Hispanic young adults in the United States. J Adolesc Health. 2006;39:627–33.CrossRefPubMedGoogle Scholar
  20. 20.
    American College of Physicians. How is a shortage of primary care physicians affecting the quality and cost of medical care? White Paper. Philadelphia: American College of Physician; 2008.Google Scholar
  21. 21.
    Richman I, Clark S, Sullivan A, Catalano J. National study of thee relation of primary care shortages to emergency department utilization. Acad Emerg Med. 2007;14:279–82.CrossRefPubMedGoogle Scholar
  22. 22.
    A consensus statement on health care transitions for young adults with special health care needs. Pediatrics. 2002;110:1304-1306.Google Scholar
  23. 23.
    Reiss JG, Gibson RW, Walker LR. Health care transition: youth, family, and provider perspectives. Pediatrics. 2005;115:112–20.CrossRefPubMedGoogle Scholar
  24. 24.
    McDonagh JE, Viner RM. Lost in transition? Between paediatric and adult services. BMJ. 2006;332:435–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Reiss J, Gibson R. Health care transition: destinations unknown. Pediatrics. 2002;110:1307–14.PubMedGoogle Scholar
  26. 26.
    Collins SR. Rising numbers of uninsured young adults: Causes, consequences, and new policies. Committee on Oversight and Government Reform, United States House of Representatives, Subcommittee on Federal Workforce, Postal Service, and the District of Columbia; 4-29-2008.Google Scholar
  27. 27.
    Davis K, Schoen C. Putting the U.S. health system on the path to high performance. Committee on Ways and Means, U.S. House of Representatives; 3-11-2009.Google Scholar
  28. 28.
    Schoen C. The Commonwealth Fund Commission on a High Performance Health System, The path to a high performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way. The Commonwealth Fund; 2-19-2009.Google Scholar
  29. 29.
    Collins SR, Nicholson JL, Rustgi SD. An analysis of leading congressional health care bills, 2007-2008: Part I, Insurance Coverage. Commonwealth Fund 2009;1223:1-114.Google Scholar
  30. 30.
    Curtis R, Neuschler E. Affording shared responsibility for universal coverage: Insights from California. Health Aff (Millwood); 2009.Google Scholar
  31. 31.
    Davis K. Uninsured in America: problems and possible solutions. BMJ. 2007;334:346–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Davis K. Universal coverage in the United States: lessons from experience of the 20th century. J Urban Health. 2001;78:46–58.PubMedGoogle Scholar
  33. 33.
    Long SK. On the road to universal coverage: impacts of reform in Massachusetts at one year. Health Aff (Millwood). 2008;27:w270–84.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Robert J. Fortuna
    • 1
    • 2
    • 3
    Email author
  • Brett W. Robbins
    • 1
    • 2
    • 3
  • Nandini Mani
    • 1
    • 2
    • 3
  • Jill S. Halterman
    • 3
  1. 1.Center for Primary CareUniversity of Rochester School of Medicine and DentistryRochesterUSA
  2. 2.Department of Internal MedicineUniversity of Rochester School of Medicine and DentistryRochesterUSA
  3. 3.Strong Children’s Research Center, Department of PediatricsUniversity of Rochester School of Medicine and DentistryRochesterUSA

Personalised recommendations