Presented at The Society for Academic Emergency Medicine annual meeting, New Orleans, LA, May 14–17, 2009.
Original Research Contribution
The Association Between Insurance Status and Emergency Department Disposition of Injured California Children
Article first published online: 17 MAY 2012
© 2012 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 19, Issue 5, pages 541–551, May 2012
How to Cite
Arroyo, A. C., Ewen Wang, N., Saynina, O., Bhattacharya, J. and Wise, P. H. (2012), The Association Between Insurance Status and Emergency Department Disposition of Injured California Children. Academic Emergency Medicine, 19: 541–551. doi: 10.1111/j.1553-2712.2012.01356.x
Supported by the Stanford Medical Scholars Research program (ACA), by a K23 grant from the National Institutes of Health NICHD 5K 23HD051595-02 (NEW), and by the Stanford NIH/NCRR CTSA award number UL1 RR025744. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health. The authors report no other disclosures or conflicts of interest.
Supervising Editor: James W. Fox, MD.
- Issue published online: 17 MAY 2012
- Article first published online: 17 MAY 2012
- Received August 23, 2011; revision received November 9, 2011; accepted November 17, 2011.
ACADEMIC EMERGENCY MEDICINE 2012; 19: 541–551 © 2012 by the Society for Academic Emergency Medicine
Objectives: This study examined the relationship between insurance status and emergency department (ED) disposition of injured California children.
Methods: Multivariate regression models were built using data obtained from the 2005 through 2009 California Office of Statewide Health Planning and Development (OSHPD) data sets for all ED visits by injured children younger than 19 years of age.
Results: Of 3,519,530 injury-related ED visits, 52% were insured by private, and 36% were insured by public insurance, while 11% of visits were not insured. After adjustment for injury characteristics and demographic variables, publicly insured children had a higher likelihood of admission for mild, moderate, and severe injuries compared to privately insured children (mild injury adjusted odds ratio [AOR] = 1.36, 95% confidence interval [CI] = 1.34 to 1.39; moderate and severe injury AOR = 1.34, 95% CI = 1.28 to 1.41). However, uninsured children were less likely to be admitted for mild, moderate, and severe injuries compared to privately insured children (mild injury AOR = 0.63, 95% CI = 0.61 to 0.66; moderate and severe injury AOR = 0.50, 95% CI = 0.46 to 0.55). While publicly insured children with moderate and severe injuries were as likely as privately insured children to experience an ED death (AOR = 0.91, 95% CI = 0.70 to 1.18), uninsured children with moderate and severe injuries were more likely to die in the ED compared to privately insured children (AOR = 3.11, 95% CI = 2.38 to 4.06).
Conclusions: Privately insured, publicly insured, and uninsured injured children have disparate patterns of ED disposition. Policy and clinical efforts are needed to ensure that all injured children receive equitable emergency care.