August 6, 2003

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Home Ownership = Fewer Emergency Department Visits by Local Population

A Johns Hopkins study has found that even in relatively impoverished neighborhoods, home ownership is linked to lower rates of use of emergency departments for emergent and general medical care.

The report, published in the August issue of the journal Academic Emergency Medicine, focused on a one-mile radius neighborhood surrounding The Johns Hopkins Hospital. In specific neighborhood blocks where less than 20 percent of housing units were owner-occupied, there were 53 ED visits per year per 100 people. That number decreased to 27 ED visits per year per 100 people in blocks where more than 45 percent of housing units were owner-occupied. Home ownership was associated with decreased ED usage regardless of health insurance status.

The study also showed that of all patients treated in the Hopkins ED, 84 percent were Baltimore city residents and 36 percent lived within one mile of the hospital. One out of four patients treated in the Hopkins ED did not have health insurance.

In addition, the report found that in areas where less than half of the population was African-America, there were 17 ED visits per year per 100 people. In areas where all residents were African-American, that percentage increased to 51 visits per year per 100 people.

"The increased ED usage in impoverished African-American neighborhoods may in large part reflect this population's increased need for emergency medical care," says Gabor D. Kelen, M.D., senior study author and chair of emergency medicine. "Neighborhood demographic and socioeconomic characteristics have long been linked to a variety of health problems, including substance abuse, violent crime, injury, sexually transmitted diseases and coronary heart disease."

Adds lead study author Guohua Li, M.D., Dr.P.H., professor of emergency medicine and of health policy and management, "Residents in this community come to the ED not only for emergent care, but also for urgent and primary care because of financial, physical or cultural barriers to other sources of medical care. To meet the health needs and reduce ED usage in these communities, it is imperative to deploy more resources."

Kelen and colleagues looked at billing data from adult residents living within a mile of the hospital who visited the Johns Hopkins ED during the calendar year 2000. They also looked at neighborhood data from the U.S. Census Bureau, and computed the number of annual ED visits per 100 people for each census block in the study area. The region consisted of 714 census blocks and 42,278 adult residents, with a total of 16,427 visits to the ED. This made up 32 percent of the ED's total patient volume for the year.

Forty-five percent of adult residents in the study area were male and 74 percent were African-American. Of all the housing units in the area, 32 percent were owner-occupied, 45 percent were renter-occupied and 23 percent were vacant. Annual number of ED visits averaged 23 per census block, yielding a rate of 39 visits per 100 residents per year.

The study was supported in part by grants from the National Institutes of Health. Coauthors were; Jurek G. Grabowski, M.P.H.; and Melissa L. McCarthy, Sc.D.

Li, Guohua et al, "Neighborhood Characteristics and Emergency Department Utilization," Academic Emergency Medicine, August 2003, Vol. 10, pages 853-859.

Johns Hopkins' Department of Emergency Medicine

Academic Emergency Medicine

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