Because Drs. Katz and Yelin are Editors of Arthritis Care & Research, review of this article was handled by the Editor of Arthritis & Rheumatism.
Systemic Lupus Erythematosus
Frequent use of the emergency department among persons with systemic lupus erythematosus†
Article first published online: 25 FEB 2010
Copyright © 2010 by the American College of Rheumatology
Arthritis Care & Research
Volume 62, Issue 3, pages 401–408, March 2010
How to Cite
Panopalis, P., Gillis, J. Z., Yazdany, J., Trupin, L., Hersh, A., Julian, L., Criswell, L. A., Katz, P. and Yelin, E. (2010), Frequent use of the emergency department among persons with systemic lupus erythematosus. Arthritis Care Res, 62: 401–408. doi: 10.1002/acr.20107
- Issue published online: 25 FEB 2010
- Article first published online: 25 FEB 2010
- Manuscript Accepted: 10 NOV 2009
- Manuscript Received: 28 JUL 2008
- National Center for Research Resources of the US Public Health Service. Grant Number: 5 M01-RR-00070
- Rosalind Russell Medical Research Center for Arthritis
- Canadian Institutes of Health Research
- NIH. Grant Numbers: K24-AR02175, RO1-AR44804
- State of California Lupus Fund
- Arthritis Foundation
- Agency for Healthcare Research and Quality
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Numbers: RO1-HS013893, P60-ARO53308
To describe characteristics of systemic lupus erythematosus (SLE) patients who are frequent users of the emergency department and to identify predictors of frequent emergency department use.
Data for this study were derived from the University of California, San Francisco Lupus Outcomes Study, a large cohort of persons with SLE who undergo annual structured interviews. Participants were categorized into 1 of 3 levels of emergency department utilization: nonusers (no visits in the preceding year), occasional users, (1–2 visits), and frequent users (≥3 visits). We compared characteristics of the 3 groups and determined predictors of frequent emergency department use (≥3 visits) using multivariate logistic regression, adjusting for a variety of potential confounding covariates.
Of 807 study participants, 499 (62%) had no emergency department visits; 230 (28%) had occasional emergency department visits (1–2 visits); and 78 (10%) had frequent (≥3 visits) emergency department visits. Frequent users were younger, less likely to be employed, and less likely to have completed college. They also had greater disease activity, worse general health status, and more depressive symptoms. Frequent emergency department users were more likely to have Medicaid as their principal insurance. In multivariate logistic regression, older age predicted a lower likelihood of frequent emergency department visits, whereas greater disease activity and having Medicaid insurance predicted a higher likelihood of frequent emergency department visits.
In persons with SLE, greater disease activity and Medicaid insurance are associated with more frequent emergency department use.