Background: Annually emergency department (ED) services are utilized by more than 100 million Americans making ED usage trends important determinants of healthcare quality, outcomes and cost. Previous workers have demonstrated the existence of disparity in various healthcare services in USA although a comprehensive analysis has not been undertaken. Dahlgren and Whitehead rainbow model has offered insights for multiple factors of influence on an individual’s health and focuses on the relationships among these factors. The Commission on Social Determinants of Health (CSDH; WHO initiatives) suggests that the social and environmental factors are at the root of most of the inequalities responsible for both communicable and non-communicable diseases.
Methods: The objectives of this study were to quantify the existing disparity in ED usage between 2010– 2017 by age, race and gender primarily using the Federal and State databases and comparing the quantitative trends with prior works from 2006–2020 that shed lights on health disparity. Single user normalization was developed to achieve randomization to reduce the heterogeneity of the database.
Results: Each age group was represented by the usage pattern of the “single” average individual revealing significantly different ED usage for different age groups. Black and white Americans as well as males and females showed large variation indicative of racial and gender disparity.
Conclusions: This is the first comprehensive meta-analysis demonstrating racial and gender specific variation in the usage of emergency health care services that exist in USA and seem to be multifactorial and age specific. Using a tool of single user normalization developed in this work as a means of randomization these disparities were quantified and may help identify such disparity trends in other regions that suffer from similar disparities.
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