Table 1. Rural Emergency Department Visits in the United States by Demographic Characteristics, Triage Category, and Disposition in 2005 and 2016.
| Characteristic | ED Visits, Unweighted No. | Estimated ED Visits, Weighted No. in Millions | Estimated ED Visits per 100 Persons | ||||||
|---|---|---|---|---|---|---|---|---|---|
| 2005 | 2016 | 2005 | 2016 | 2005, No. (95% CI) | 2016, No. (95% CI) | RD | RC (95% CI) | P Value | |
| Total ED visits | 4047 | 2759 | 16.7 | 28.4 | 36.5 (17.2 to 55.9) | 64.5 (29.3 to 99.7) | 28.9 | 2.2 (1.2 to 3.3) | .001 |
| Visits by age, y | |||||||||
| <18 | 937 | 540 | 3.9 | 5.8 | 40.2 (17.7 to 62.8) | 61.8 (25.9 to 97.7) | 21.6 | 1.1 (−0.1 to 2.4) | .07 |
| 18-44 | 1538 | 996 | 6.5 | 10.4 | 46.9 (21.4 to 72.4) | 81.6 (37.2 to 126.0) | 34.7 | 2.3 (1.1 to 3.5) | .002 |
| 45-64 | 782 | 642 | 3.1 | 6.3 | 27.5 (12.8 to 42.3) | 53.9 (26.3 to 81.5) | 26.5 | 1.6 (0.7 to 2.5) | .004 |
| ≥65 | 790 | 581 | 3.1 | 5.9 | 50.0 (23.2 to 76.7) | 81.6 (31.8 to 131.4) | 31.6 | 1.1 (−0.7 to 3.0) | .19 |
| Visits by sex | |||||||||
| Male | 1874 | 1293 | 7.6 | 13.3 | 37.1 (17.2 to 56.9) | 65.5 (29.9 to 101.2) | 26.1 | 1.6 (0.6 to 2.6) | .006 |
| Female | 2173 | 1466 | 9.1 | 15.1 | 43.8 (19.8 to 67.7) | 72.7 (32.8 to 112.6) | 28.9 | 1.7 (0.3 to 3.1) | .02 |
| Visits by race/ethnicity | |||||||||
| White | 3464 | 2298 | 13.5 | 22.5 | 39.2 (17.8 to 60.6) | 65.3 (28.5 to 102.1) | 26.1 | 1.6 (0.4 to 2.8) | .01 |
| Black | 366 | 268 | 2.1 | 3.4 | 58.9 (5.6 to 112.1) | 95.5 (9.7 to 181.4) | 36.6 | 1.1 (−2.3 to 4.6) | .47 |
| Hispanic | 172 | 161 | 0.8 | 2.0 | 48.6 (6.8 to 90.4) | 91.9 (31.2 to 152.7) | 43.3 | 0.9 (−1.9 to 3.7) | .48 |
| Visits by insurance statusa | |||||||||
| Private insurance | 1727 | 1064 | 6.8 | 9.9 | 30.0 (13.2 to 42.8) | 38.3 (17.7 to 58.8) | 8.3 | 0.5 (−0.3 to 1.4) | .21 |
| Medicare | 947 | 722 | 3.8 | 6.4 | 48.7 (22.8 to 74.5) | 74.5 (34.0 to 114.9) | 25.8 | 1.3 (−0.6 to 3.2) | .16 |
| Medicaid | 1081 | 969 | 4.4 | 9.7 | 56.2 (24.9 to 87.5) | 112.6 (52.6 to 172.5) | 56.4 | 4.1 (2.1 to 6.1) | .001 |
| No insurance | 590 | 330 | 2.7 | 3.4 | 44.0 (14.8 to 73.1) | 66.6 (6.5 to 126.7) | 22.6 | 2.7 (0.2 to 5.2) | .04 |
| Visits for ACSCsb | 429 | 328 | 1.3 | 1.5 | 3.6 (1.7 to 5.6) | 4.5 (2.1 to 6.9) | 0.9 | 0.1 (0 to 0.2) | .13 |
| Visits by disposition category, %b | |||||||||
| Hospitalized | 357 | 141 | 1.6 | 1.8 | 9.3 (4.1 to 14.5) | 6.3 (1.5 to 11.1) | −3.0 | −0.3 (−0.5 to −0.1) | .009 |
| Transferred | 149 | 141 | 0.6 | 1.2 | 3.3 (1.6 to 5.1) | 4.2 (1.3 to 7.0) | 0.9 | 0.1 (0 to 0.2) | .05 |
| Visits by triage categoryb | |||||||||
| Immediate | 338 | 7 | 1.6 | 0.1 | 9.6 (1.8 to 17.5) | NAc | NAc | NAc | NAc |
| Emergent | 442 | 140 | 1.8 | 1.8 | 10.9 (2.9 to 18.9) | 6.2 (1.2 to 11.4) | −4.7 | −0.8 (−1.2 to −0.4) | .002 |
| Urgent | 1357 | 985 | 5.8 | 10.5 | 39.9 (12.0 to 57.9) | 36.8 (15.9 to 57.8) | −3.1 | −0.6 (−1.3 to 0.2) | .14 |
| Semiurgent | 642 | 755 | 2.3 | 8.2 | 13.7 (4.1 to 23.3) | 28.9 (12.5 to 45.3) | 15.2 | 2.2 (0.6 to 3.7) | .01 |
| Nonurgent | 439 | 179 | 1.8 | 1.7 | 10.9 (2.0 to 19.7) | 6.1 (1.7 to 10.4) | −4.8 | −0.5 (−0.9 to −0.1) | .03 |
| Mean triage categoryd | NA | NA | NA | NA | 3.1 (2.8 to 3.4) | 3.4 (3.3 to 3.6) | 0.3 | 0.5 (0.2 to 0.7) | .002 |
Abbreviations: ACSC, ambulatory care–sensitive conditions; ED, emergency department; NA, not applicable; RD, rate difference; RC, annual rate of change.
These denominators represent 2008 to 2016 because 2008 was the first year the US Census Bureau provided data in a way to allow for identification of urban and rural populations by payer type.
Denominator is ED visits for each year; proportions are the percentage of total estimated ED visits. Due to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision transition occurring in 2015, we reported ACSCs for 2005 to 2015 to avoid invalid comparisons with 2016 data.
Estimates based on a sample of less than 30 unweighted records are unreliable and are thus not reported.
Calculated by assigning a value of 1 (most acute) through 5 (least acute) to each of the 5 triage categories and then taking the mean for each year with confidence intervals; P value is trend during study for mean triage category.