1. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Injury and illness episodes presenting to U.S. emergency departments by patient ethnicity Catharine W Burt, EdD, and Irma E Arispe, PhD American Public Health Association Annual Meeting November 6, 2006

2. Topics Survey background New imputation strategy Estimation of injury and illness episodes Comparisons across race, sex, age and Hispanic or Latino origin

3. NHAMCS background National Hospital Ambulatory Medical Care Survey – NHAMCS Annual, nationally representative sample of ED visits to non-federal, general and short stay hospitals Multi-stage sample design 112 Geographic PSUs; 456 hospitals with 24-hour EDs; 37,000 emergency visits within hospitals

4. (con’t) Abstraction of patient demographics, diagnoses and services provided from medical records Sample weights for 2003 and 2004 adjusted for hospital nonresponse (86%) and modified to produce average annual estimates

5. Illness and injury episode definitions Episode – initial visit for condition (i.e., excludes follow-up visits) Injury – reason for visit, diagnosis, or E-code related to trauma, poisoning, or adverse effect of medical treatment Illness – all other visits

6. Race and ethnicity definitions Multiple race entries are allowed White, black/African American, other (Asian, Native Hawaiian, Native American, multiple) 11.8% missing Ethnicity Hispanic or Latino origin vs. not 15.4% missing

7. Imputation for missing race and ethnicity Race: 3-digit primary diagnosis, immediacy, geographic region Ethnicity: 3-digit diagnosis, immediacy, state

8. Results

9. Annual rate of ED episodes for injury by patient ethnicity and age: United States, 2003-04 101 93 117 99 94 121 132 143 179 141 95 120 All ages<1515-2425-4445-6465+ 0 50 100 150 200 Number of episodes per 1,000 persons HispanicNon-Hispanic Hispanic Non-Hispanic 1 1 Significant difference between Hispanic and non-Hispanic persons (p<.05). 1 1 1

10. Annual rate of ED episodes for illness by patient ethnicity and age: United States, 2003-04 220 272 187 174 205 369 220 235 218 170 303 All ages<1515-2425-4445-6465+ 0 100 200 300 400 500 Number of episodes per 1,000 persons HispanicNon-Hispanic Hispanic Non-Hispanic 1 1 Significant difference between Hispanic and non-Hispanic persons (p<.05). 11

11. Annual rate of ED episodes for injury and illness by patient ethnicity and sex: United States, 2003-04 112 89 189 253 143 122 188 250 MaleFemaleMaleFemale 0 50 100 150 200 250 300 Number of episodes per 1,000 persons HispanicNon-Hispanic Hispanic Non-Hispanic Injury Illness 1 1 Significant difference between Hispanic and non-Hispanic persons (p<.05). 1

12. Annual rate of ED episodes for injury and illness by patient ethnicity and race: United States, 2003-04 92 333 201 751 130 186 199 402 WhiteBlackWhiteBlack 0 100 200 300 400 500 600 700 800 Number of episodes per 1,000 persons HispanicNon-Hispanic Hispanic Non-Hispanic Injury Illness 1 1 Significant difference between Hispanic and non-Hispanic persons (p<.05). 1 1

13. Drill down for race differences Race x Sex x Ethnicity Contextual variables from patient’s ZIP code Percent of neighborhood Foreign born Speaks English poorly Median Household income

14. Annual rate of hospital ED injury episodes per 1,000 population by ethnicity, race, and sex: United States, 2003-04 Episodes per 1,000 population BlackWhite 0 50 100 150 200 250 300 350 400 450 500 MaleFemaleMaleFemale HispanicNon-Hispanic Confidence Interval l

15. Annual rate of hospital ED illness episodes per 1,000 population by ethnicity, race, and sex: United States, 2003-04 Black White Episodes per 1,000 population 0 100 200 300 400 500 600 700 800 900 1000 MaleFemaleMaleFemale HispanicNon-Hispanic Confidence Interval

16. INJURY episodes: Percent of patient's neighborhood that is foreign-born by ethnicity, race, and sex: United States, 2003-04 0 5 10 15 20 25 30 MaleFemaleMaleFemale Percent of neighborhood HispanicNon-Hispanic Confidence Interval Black White

17. ILLNESS episodes: Percent of patient’s neighborhood that is foreign born by ethnicity, race and sex: United States, 2003-04 0 5 10 15 20 25 30 MaleFemaleMaleFemale Percent of neighborhood HispanicNon-Hispanic Confidence Interval Black White

18. INJURY episodes: Percent of patient's neighborhood not speaking English well by ethnicity, race, and sex: United States, 2003-04 0 5 10 15 MaleFemaleMaleFemale Percent of neighborhood HispanicNon-Hispanic Confidence Interval Black White

19. ILLNESS episode: Percent of patient's neighborhood not speaking English well by ethnicity, race and sex: United States, 2003-04 0 2 4 6 8 10 12 14 MaleFemaleMaleFemale Percent of neighborhood HispanicNon-Hispanic Confidence Interval Black White

20. Median household income from patient's neighborhood by ethnicity, race, and sex: United States, 2003-04 30000 40000 50000 MaleFemaleMaleFemale Dollars HispanicNon-Hispanic Confidence Interval Black White

21. Conclusions Use of new imputation strategy for providing nation estimates for Hispanic/Latino populations Hispanics are less likely to present for injury but equally likely to present for illness. Race differences among Hispanics in ED utilization persist. Contextual variables do not inform observed high rate of episodes by black Hispanics