The risk of emergency department visits in adults living in rural France. (13th November 2019)

• Record Type: Journal Article
• Authors: Mercier, G; Rodwin, Victor; Quantin, Catherine; Chernew, Michael; Gusmano, Michael
• Is Part Of: European journal of public health. Volume 29(2019)Supplement 4
• Publication Date: 2019-11-13
• Subjects: Epidemiology -- Europe -- Periodicals; Public health -- Europe -- Periodicals; 362.109405
• DOI: 10.1093/eurpub/ckz186.339
• Languages: English
• ISSNs: 1101-1262

Abstract

Abstract: Background: Individuals living in rural areas have poorer health outcomes due to complex causal pathways related to socio-economic status, health behaviors and lower use of primary care. Emergency department visits without inpatient admission (hereafter ED visits) are an indirect measure of access to primary care. Objective: To analyze the determinants of ED visits among French adults living in rural areas. Methods: We analyze survey data from the CONSTANCES cohort study, a representative sample of French adults aged 18-69 years. These data on individuals' demographics, self-reported and physician-reported clinical indicators, and individual socio-economic status, are linked to France's claims database (SNIIRAM). We analyze the risk of having at least one ED visit, in 2016, using a multivariate logistic regression model. Results: Among 12, 834 adults included in the study, 1, 412 (11%) had at least one ED visit in 2016. After adjustment, the ED visit risk was associated negatively with female gender (OR = 0.87; p < 0.01), age (OR = 0.97; p < 0.01), secondary education (OR = 0.85; p = 0.03), higher use of GPs (OR = 0.99; p = 0.02); and positively associated with the number of comorbidities (OR = 1.1; p < 0.01), poorer self-reported health status (OR = 1.01; p = 0.02), a higher self-reported depression score (OR = 1.01; p = 0.02), and acute care inpatient admissions (OR = 2.4; p < 0.01). Conclusions: These results suggest that, among adults living in rural France, those with a lower educational level are at higher risk of ED visits. Policy implications: To reduce health disparities among rural and urban areas, policymakers and primary care professionals should focus on targeted outreach strategies to identify high-needs individuals. Key messages: The risk of emergency department visit varies significantly among adult living in rural France. Among adults living in rural France, those with a lower educational level are at higher risk of ED visit.