Emergency department visits among rural and urban older adults: disparities in ambulatory and emergency care sensitive conditions

Cameron J Gettel; Courtney Kitchen; Craig Rothenberg; Yuxiao Song; Ryan Koski-Vacirca; Katherine Schaffer; Alexander T Janke; Nicholas M Mohr; Margaret Greenwood-Ericksen; Arjun K Venkatesh

doi:10.1186/s12913-025-13161-2

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Emergency department visits among rural and urban older adults: disparities in ambulatory and emergency care sensitive conditions

Journal article

Open access

Peer reviewed

Emergency department visits among rural and urban older adults: disparities in ambulatory and emergency care sensitive conditions

Cameron J Gettel, Courtney Kitchen, Craig Rothenberg, Yuxiao Song, Ryan Koski-Vacirca, Katherine Schaffer, Alexander T Janke, Nicholas M Mohr, Margaret Greenwood-Ericksen and Arjun K Venkatesh

BMC health services research, Vol.25(1), 975

07/24/2025

DOI: 10.1186/s12913-025-13161-2

PMCID: PMC12291402

PMID: 40707938

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Abstract

Older adults in rural geographies may be uniquely vulnerable to difficulty accessing outpatient care, and therefore more reliant on emergency department (ED) care. We compared ED utilization for ambulatory care sensitive conditions (ACSCs) and emergency care sensitive conditions (ECSCs) among rural and urban Medicare beneficiaries. We conducted a pooled cross-sectional analysis of 2016-2020 Medicare Current Beneficiary Survey data, assessing ED visitation rates for ACSCs and ECSCs. We present ED visit rates per 100 beneficiary-years and estimated logistic regression models to quantify the odds of having any ED visit, any ACSC-related ED visit, or any ECSC-related ED visit in a given year among older adults in rural and urban areas, adjusting for sociodemographic and health characteristics. Our sample included 70,830 beneficiary-years, with 17,052 (24.1%) being from beneficiaries residing in rural areas. Rural beneficiaries had higher ED visit rates, with a weighted mean (SD) of 59.2 ED visits (14.1) per 100 beneficiary-years across study years, 11.5 (1.3) for ACSC-related, and 20.6 (3.5) for ECSC-related visits, compared to 43.2 (9.2), 7.2 (0.9), and 15.2 (1.9) ED visits, respectively, for urban beneficiary-years. In adjusted models, rural beneficiaries had a 49% higher odds of having an ED visit (OR: 1.49, 95% CI: 1.40-1.59), a 30% higher odds of an ACSC-related ED visit (OR: 1.30, 95% CI: 1.04-1.64), and a 26% higher odds of an ECSC-related ED visit (OR: 1.26, 95% CI: 1.05-1.50) within a given year when compared to urban counterparts. Rural Medicare beneficiaries consistently showed higher ED utilization for ACSCs and ECSCs compared to urban beneficiaries, highlighting potential disparities in healthcare access and a need for targeted or policy-based interventions.

United States

Aged

Aged, 80 and over

Ambulatory Care - statistics & numerical data

Cross-Sectional Studies

Emergency Room Visits

Emergency Service, Hospital - statistics & numerical data

Female

Health Services Accessibility - statistics & numerical data

Healthcare Disparities - statistics & numerical data

Humans

Male

Medicare - statistics & numerical data

Rural Population - statistics & numerical data

Urban Population - statistics & numerical data

Details

Title: Subtitle: Emergency department visits among rural and urban older adults: disparities in ambulatory and emergency care sensitive conditions
Creators: Cameron J Gettel - Yale University
Courtney Kitchen - Yale University
Craig Rothenberg - Yale University
Yuxiao Song - Yale University
Ryan Koski-Vacirca - Yale University
Katherine Schaffer - Eastern Virginia Medical School
Alexander T Janke - VA Center for Clinical Management Research
Nicholas M Mohr - University of Iowa
Margaret Greenwood-Ericksen - University of New Mexico
Arjun K Venkatesh - Yale University
Resource Type: Journal article
Publication Details: BMC health services research, Vol.25(1), 975
DOI: 10.1186/s12913-025-13161-2
PMID: 40707938
PMCID: PMC12291402
NLM abbreviation: BMC Health Serv Res
ISSN: 1472-6963
eISSN: 1472-6963
Publisher: BioMed Central
Grant note: R03AG073988 / NIA NIH HHS SCON-10000824 / National Academy of Medicine
Language: English
Date published: 07/24/2025
Academic Unit: Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
Record Identifier: 9984865436602771

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