Home Emergency Medicine Racial, Ethnic Disparities Seen in ED Discharge Against Medical Advice

Racial, Ethnic Disparities Seen in ED Discharge Against Medical Advice

In unadjusted analyses, Black and Hispanic patients have increased odds of emergency department discharge against medical advice

By Elana Gotkine HealthDay Reporter

WEDNESDAY, Nov. 29, 2023 (HealthDay News) — Black and Hispanic patients appear to have increased odds of emergency department discharges against medical advice (DAMA), according to a study published online Nov. 28 in JAMA Network Open.

Jennifer W. Tsai, M.D., from the Yale University School of Medicine in New Haven, Connecticut, and colleagues characterized the current patterns of racial and ethnic disparities in rates of emergency department DAMA. The study sample included 33,147,251 visits to 989 hospitals, representing an estimated 143 million emergency department visits in 2019.

The researchers found that DAMA rates were higher for Black than Hispanic and White patients (2.1 versus 1.6 and 1.4 percent); for males than females (1.7 versus 1.5 percent); and for those with no insurance (2.8 percent), with lower income (<$27,999; 1.9 percent), and aged 35 to 49 years (2.2 percent). At metropolitan teaching hospitals and hospitals that served greater proportions of racial and ethnic minoritized patients (serving 57.9 percent), DAMA visits were highest (1.8 and 2.1 percent, respectively). The odds of DAMA were greater for Black and Hispanic than White patients (odds ratios, 1.45 and 1.16, respectively). The adjusted odds ratio for DAMA was lower for Blacks (adjusted odds ratio, 1.18) and no longer significant for Hispanic versus White patients after adjustment for sociodemographic characteristics. DAMA disparities reversed after additional adjustment for hospital random intercepts (adjusted odds ratios, 0.94 and 0.68 for Black and Hispanic patients, respectively, versus White patients).

“Measuring and addressing hospital-level variations in DAMA rates and disparities is an opportunity to improve equitable access to hospital care,” the authors write.

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