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Osula V, Rusk S, Hao L, Hansoti B, Gemmill A, Hong X, Wang G, Pearson C, Adams WG, Wang X. Prospective Cohort Study of Emergency Department Visit Frequency and Diagnoses Before and During COVID-19 Pandemic in Urban, Low-Income, US- and Foreign-Born Mothers in Boston, MA. West J Emerg Med 2023; 24:1117-1127. [PMID: 38165194 PMCID: PMC10754186 DOI: 10.5811/westjem.59639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 01/03/2024] Open
Abstract
Background The coronavirus 2019 (COVID-19) pandemic fundamentally changed how populations interface with the healthcare system. Despite historical spikes in US mortality during the pandemic, emergency department (ED) visits were paradoxically low. This is a concerning phenomenon that raises a red flag regarding access to care, especially among vulnerable populations. In this study we sought to understand how ED utilization evolved during the COVID-19 pandemic among traditionally understudied, low-income, racially diverse US- and foreign-born mothers. Methods This is a secondary analysis of a pre-existing dataset of 3,073 participants enrolled in the Boston Birth Cohort at birth and followed prospectively. We obtained ED visit diagnoses from 2019 and 2020 via electronic health records, categorized according to the International Classification of Diseases, 10th Revision, and compared them using graph plots, chi-square, and negative binomial regression. Results The number of ED visits decreased by 29.1% (P < 0.001) from 2019 (1,376) to 2020 (976). However, visits for infectious and parasitic diseases, including COVID-19, increased by 90.6% (32:61) with COVID-19 accounting for 77% of those visits in 2020 (47/61). Mental health-related visits increased by 40.9% (44:62), with diagnoses of alcohol use disorder increasing by 183% (6:17). Regression analysis showed 50% less ED utilization among foreign- vs US-born participants; however, the increase in infectious diseases visits was greater among foreign-born compared to US-born mothers (185% vs 26%, P = 0.01), while the increase in mental health diagnoses was greater among US-born mothers (69% vs -33%, P = 0.10). Conclusion Despite a decrease in total ED visits during the pandemic, there was an increase in COVID-19- (immigrant > US born) and mental health- (US-born only) related visits. Our findings demonstrate that EDs remain a critical access point for care for minority populations and have implications for preparedness, resources, and services of EDs in urban settings to better address the needs of communities. However, alternative avenues for healthcare services for these populations, particularly during health crises, warrant further investigation.
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Affiliation(s)
- Valerie Osula
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Serena Rusk
- Johns Hopkins Bloomberg School of Public Health, Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Baltimore, Maryland
| | - Lingxin Hao
- Johns Hopkins University, Department of Sociology, Baltimore, Maryland
| | - Bhakti Hansoti
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland
| | - Alison Gemmill
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Baltimore, Maryland
| | - Xiumei Hong
- Johns Hopkins Bloomberg School of Public Health, Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Baltimore, Maryland
| | - Guoying Wang
- Johns Hopkins Bloomberg School of Public Health, Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Baltimore, Maryland
| | - Colleen Pearson
- Boston University School of Medicine, Boston, Massachusetts
- Boston Medical Center, Department of Pediatrics, Boston, Massachusetts
| | - William G. Adams
- Boston University School of Medicine, Boston, Massachusetts
- Boston Medical Center, Department of Pediatrics, Boston, Massachusetts
| | - Xiaobin Wang
- Johns Hopkins Bloomberg School of Public Health, Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, Maryland
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Loeb TB, Viducich I, Smith-Clapham AM, Adkins-Jackson P, Zhang M, Cooley-Strickland M, Davis T, Pemberton JV, Wyatt GE. Unmet need for mental health services utilization among under-resourced Black and Latinx adults. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2023; 41:149-159. [PMID: 36521110 PMCID: PMC10267286 DOI: 10.1037/fsh0000750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Substantial unmet need for mental health services (MHS) exists in the United States, with pronounced disparities among people of color. Research highlights the need to identify facilitators and barriers to MHS utilization among Black and Latinx individuals to better promote overall health. We tested an expanded model of MHS use based on Andersen's (1995) conceptual framework of health care utilization. Associations were examined between sociodemographic variables, trauma and adversity burden, living with HIV, and unmet need for MHS in a community sample of underresourced Black and Latinx individuals. Barriers to MHS utilization are described. METHODS Five-hundred participants completed the UCLA Life Adversities Screener (LADS), sociodemographic measures, and items assessing need for and barriers to MHS. RESULTS 228 (46%) participants reported a need for MHS; of these, 115 (51%) reported receiving MHS. A binomial logistic regression model estimated the relative contribution of the LADS on need for MHS. Severity of LADS, younger age, and living with HIV predicted unmet need for MHS. Barriers to MHS included financial and time constraints and health system-related issues. One-way analysis of variance (ANOVA) tests revealed differences in mental health symptoms by MHS need. DISCUSSION The unmet need for MHS in this sample of Black and Latinx individuals highlights the importance of addressing the systemic roots of trauma and adversity burden, and eliminating structural barriers to treatment to reduce existing health and mental health inequities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Tamra B Loeb
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute, University of California, Los Angeles
| | - Isabella Viducich
- Luskin School of Social Welfare, University of California, Los Angeles
| | - Amber M Smith-Clapham
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute, University of California, Los Angeles
| | | | - Muyu Zhang
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute, University of California, Los Angeles
| | - Michele Cooley-Strickland
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute, University of California, Los Angeles
| | - Teri Davis
- Department of Clinical Psychology, Chicago School of Professional Psychology
| | - Jennifer V Pemberton
- Department of Educational Psychology and Counseling, California State University
| | - Gail E Wyatt
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute, University of California, Los Angeles
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