COVID-19 pandemic-associated changes in overall emergency department visits by age group, race, and ethnicity - United States, January 2019-April 2022

Amanda R Smith; Jourdan DeVies; Kelly Carey; Michael Sheppard; Lakshmi Radhakrishnan; Rashid Njai; Umed A Ajani; Karl Soetebier; Kathleen Hartnett; Jennifer Adjemian

doi:10.1016/j.ajem.2023.04.005

COVID-19 pandemic-associated changes in overall emergency department visits by age group, race, and ethnicity - United States, January 2019-April 2022

Am J Emerg Med. 2023 Jul:69:121-126. doi: 10.1016/j.ajem.2023.04.005. Epub 2023 Apr 14.

Authors

Affiliations

¹ Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, 2500 Century Center, Mailstop V25-3, Atlanta, GA 30345, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, 2400 Century Center, Mailstop V24-5, Atlanta, GA 30345, USA. Electronic address: [email protected].
² Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, 2500 Century Center, Mailstop V25-3, Atlanta, GA 30345, USA; ICF International, 2635 Century Pkwy NE Suite 1000, Atlanta, GA 30345, USA. Electronic address: [email protected].
³ Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, 2500 Century Center, Mailstop V25-3, Atlanta, GA 30345, USA. Electronic address: [email protected].
⁴ Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, 2500 Century Center, Mailstop V25-3, Atlanta, GA 30345, USA. Electronic address: [email protected].
⁵ Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, 2500 Century Center, Mailstop V25-3, Atlanta, GA 30345, USA. Electronic address: [email protected].
⁶ Office of Minority Health and Health Equity, Office of the Deputy Director for Public Health Service and Implementation, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop TW-3, Atlanta, GA 30341, USA. Electronic address: [email protected].
⁷ Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, 2500 Century Center, Mailstop V25-3, Atlanta, GA 30345, USA. Electronic address: [email protected].
⁸ Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, 2500 Century Center, Mailstop V25-3, Atlanta, GA 30345, USA. Electronic address: [email protected].
⁹ Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, 2500 Century Center, Mailstop V25-3, Atlanta, GA 30345, USA. Electronic address: [email protected].
¹⁰ Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, 2500 Century Center, Mailstop V25-3, Atlanta, GA 30345, USA. Electronic address: [email protected].

Abstract

Background: ED data are an important source of surveillance data for monitoring many conditions of public health concern and are especially useful in describing trends related to new, or unusual public health events. The COVID-19 pandemic led to significant changes in emergency care seeking behavior. We described the trends in all-cause emergency department (ED) visit volumes by race, ethnicity, and age using ED data from the National Syndromic Surveillance Program (NSSP) during December 30, 2018-April 2, 2022.

Methods: We described total and race, ethnicity, and age group-specific ED visit volumes during the COVID-19 pandemic by comparing quarterly visit volumes during the pandemic period to the relevant quarters in 2019. We quantified the variability of ED visits volumes by calculating the coefficient of variation in mean weekly ED visit volume for each quarter during Q1 2019-Q1 2022.

Results: Overall ED visits dropped by 32% during Q2 2020, when the COVID-19 pandemic began, then rebounded to 2019 baseline by Q2 2021. ED visits for all race, ethnicity, and age groups similarly dropped in Q2 2020 and adults of all race and ethnicity groups rebounded to at or above pre-pandemic levels while children remained at or below the pre-pandemic baseline except during Q3 2021. There was larger variation in mean weekly ED visits compared to the respective quarter in 2019 for 6 of 9 quarters during Q1 2020-Q1 2022.

Conclusions: ED utilization fluctuated considerably during the COVID-19 pandemic. Overall ED visits returned to within 5% of 2019 baseline during Q2 2021, however, ED visits among children did not return to the 2019 baseline until Q3 2021, then again dropped below the 2019 baseline in Q4 2021. Trends in ED visit volumes were similar among race and ethnicity groups but differed by age group. Monitoring ED data stratified by race, ethnicity and age can help understand healthcare utilization trends and overall burden on the healthcare system as well as facilitate rapid identification and response to public health threats that may disproportionately affect certain populations.

Keywords: COVID-19; Emergency department; Race and ethnicity; Surveillance.

Published by Elsevier Inc.

MeSH terms

Adult
COVID-19* / epidemiology
Child
Delivery of Health Care
Emergency Service, Hospital
Ethnicity
Humans
Pandemics
United States / epidemiology