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 the population was African-American, 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," said Gabor D. Kelen, 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."
Added lead study author Guohua Li, 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. Co-authors were Jurek G.
Grabowski and Melissa L. McCarthy.
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