Clinical and Economic Burden of Emergency Department Visits Due to Gastrointestinal Diseases in the United States

Parvathi A Myer MD; MHS; Ajitha Mannalithara PhD; Gurjot Singh MD; Gurkirpal Singh MD; Pankaj J Pasricha MD; Uri Ladabaum MD; MS

Disclosures

Am J Gastroenterol. 2013;108(9):1496-1507. 

In This Article

Abstract and Introduction

Abstract

Objectives: Gastrointestinal (GI) emergencies may cause substantial morbidity. Our aims were to characterize the national clinical and economic burden of GI visits to emergency departments (EDs) in the United States.

Methods: We performed an observational cross-sectional study using the 2007 Nationwide Emergency Department Sample, the largest US all-payer ED database, to identify the leading causes for ED visits due to GI diseases and their associated charges, stratified by age and sex. Logistic regression was used to analyze predictors of hospitalization after an ED visit.

Results: Of the 122 million ED visits in 2007, 15 million (12%) had a primary GI diagnosis. The leading primary GI diagnoses were abdominal pain (4.7 million visits), nausea and vomiting (1.6 million visits), and functional disorders of the digestive system (0.7 million visits). The leading diagnoses differed by age group. The fraction of ED visits resulting in hospitalization was 21.6% for primary GI diagnoses vs. 14.7% for non-GI visits. Women had more ED visits with a primary GI diagnosis than men (58.5 (95% CI 56.0–60.9) vs. 41.6 (95% CI 39.8–43.3) per 1000 persons), but lower rates of subsequent hospitalization (20.0% (95% CI 19.4–20.7%) vs. 24.0% (95% CI 23.3–24.6%)). There were no differences in hospitalization rates between sexes after adjustment by age, primary GI diagnosis, and Charlson Comorbidity Score. The total charges for ED visits with a primary GI diagnosis in 2007 were $27.9 billion.

Conclusions: GI illnesses account for substantial clinical and economic burdens on US emergency medical services.

Introduction

The utilization of emergency department (ED) services has increased dramatically in the United States over the last 15 years. Between 1997 and 2007, the annual number of ED visits in the United States increased by 23%, twice the rate of growth of the US population.[1] Gastrointestinal (GI) diseases are a leading cause for ambulatory care visits.[2–5] The current national clinical and economic burden of GI emergencies has not been well characterized.

Previous studies of GI diseases in ambulatory care have identified important general as well as age-specific and sex-specific trends.[2–9] From 1992 to 2005, annual age-adjusted rates of outpatient visits for GI problems increased by one-third from 26.4/100 to 35.3/100 persons.[9] In 2004, there were 72 million ambulatory visits in the United States with a primary GI diagnosis, with the highest visit rates observed among those >65 years of age.[2] Women had a 20% higher rate of ambulatory visits than men, with no differences observed between Caucasians and African Americans.[2]

Our aims were to characterize the national clinical and economic burden of GI visits to EDs in the United States, with attention to differences by age and sex. We used the Nationwide Emergency Department Sample (NEDS) data for 2007, which constitutes the largest all-payer database capturing ED visits in the United States. We determined the leading causes for ED visits due to GI diseases based on age and sex. Given the documented disparities in the care of women vs. men for conditions such as coronary artery disease, stroke, hyperlipidemia, and chronic kidney disease,[10,11,12,13,14,15,16] we explored the sex-specific rates of hospitalization following ED visits, accounting for presenting diagnoses and comorbidities. Finally, we determined the types of insurance covering these ED visits and the associated charges, stratified by age.

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