Purpose: Coronary heart disease (CHD) and stroke are leading causes of morbidity and mortality in the U.S. Over 92 million Americans have been diagnosed with CHD/stroke and have more costly emergency department (ED) visits to manage acute and chronic symptoms. These visits are often attributed to poor access to primary care, advanced age, and poor social support. Social determinants of health (SDoH) have been suggested for a variety of health outcomes, yet their relation to healthcare utilization such as ED visits among individuals with CHD/stroke is unclear. We hypothesized that SDoH would be associated with having ≥1 ED visit(s) in the prior 12 months among patients with CHD and stroke.
Methods: A cross-sectional analysis of the 2010-2016 National Health Interview Survey was conducted among those who self-reported CHD/stroke diagnosis. Logistic regression analyses were performed with the outcome reporting ≥ 1 ED visit for any reason in the prior 12 months. SDoH examined were race, employment status, poverty, insurance status, and marital status.
Results: We included 6,930 participants with diagnosis of CHD/stroke. The mean age (±sd) was 67.09 (±0.10) years. After adjusting for age, sex, perceived health status, Blacks (OR: 1.27, (95%CI: 1.14-1.41) and unmarried persons (OR: 1.21, 95% CI: 1.11-1.31) were more likely to report having at ≥ 1 ED visits than their White and married counterparts. Compared to Whites, Asians (OR: 0.65, 95%CI: 0.51-0.81) had lower odds of having ≥ 1 ED visit. Those who were employed were less likely (OR: 0.75, 95%CI: 0.67-0.83) to have ED visits compared to those who were unemployed. Those who were not poor/near poor (OR: 0.86, 95%CI: 0.78-0.96) had lower odds of ED visits than the poor.
Conclusions: Being Black, poor, unemployed and unmarried were associated with a higher odds of ED visits in the prior 12 months among those with CHD/stroke. Targeted and culturally-appropriate strategies that address SDoH among this vulnerable, high risk population may help prevent costly ED visits.