Correlates of Emergency Department Service Utilization Among U.S. Chinese Older Adults

Abstract

Older adults visit emergency departments (EDs) at a disproportionally higher rate than other age groups. Prior studies examining racial disparities in ED utilization focus on African Americans and Hispanics. There is a dearth of information on ED utilization patterns among older Asian Americans despite the evidence that ED expenditures in Asian Americans are comparable to that of Caucasians. To address this knowledge gap, we examined factors associated with ED service utilization in the largest Asian subgroup, U.S. Chinese older adults. Cross-sectional data from the Population Study of Chinese Elderly in Chicago (PINE) (N = 3,157) were used. Multivariate negative binomial regression analyses were conducted to examine significant factors associated with ED use. Higher education (rate ratio [RR] = 1.03, 95% confidence interval [CI] 1.00–1.05) and acculturation levels (RR = 1.02, CI 1.00–1.04), fewer people in the household (RR = 0.94, CI 0.88–0.99), health insurance coverage (RR = 1.34, CI 1.01–1.78), lower income (RR = 0.89, CI 0.80–0.99), poorer perceived health (RR = 0.67, CI 0.58–0.77), more functional limitations (RR = 1.09, CI 1.06–1.13) and depressive symptoms (RR = 1.04, CI 1.02–1.07), and a history of heart disease (RR = 2.28, CI 1.83–2.84), stroke (RR = 1.68, CI 1.20–2.35), cancer (RR = 1.86, CI 1.31–2.63), and hip fracture (RR = 1.42, CI 1.02–1.98) were associated with higher rates of ED visits. Our findings highlight several significant correlates of ED use in U.S. Chinese older adults. Culturally-appropriate interventions modifying these factors have the potential to decrease ED visits and improve care outcomes in this population.

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Funding

Dr. Dong was supported by National Institute on Aging Grants R01AG042318, R01MD006173, R01CA163830, R34MH100443, R34MH100393, and RC4AG039085; a Paul B. Beeson Award in Aging; the Starr Foundation; the American Federation for Aging Research; the John A. Hart-ford Foundation; and the Atlantic Philanthropies.

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DK and XD take responsibility for the study concept and design. Acquisition of data: XD. Analysis and interpretation of data: DK, XD. Drafting of manuscript: DK, XD. Critical revision of the manuscript for important intellectual content: DK, ML, YIW, JW, BCS, XD. Acquisition of funding: XD.

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Correspondence to Dexia Kong.

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The authors declare that they have no conflict of interest.

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Kong, D., Li, M., Wong, Y.I. et al. Correlates of Emergency Department Service Utilization Among U.S. Chinese Older Adults. J Immigrant Minority Health 21, 938–945 (2019). https://doi.org/10.1007/s10903-018-0828-0

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Keywords

  • Minoirty aging
  • Chinese
  • Emergency department
  • Health services utilization