Relationship between racial disparities in ED wait times and illness severity

Abstract

Background: Prolonged emergency department (ED) wait times could potentially lead to increased mortality. Studies have demonstrated that black patients waited significantly longer for ED care than nonblack patients. However, the disparity in wait times need not necessarily manifest across all illness severities. We hypothesize that, on average, black patients wait longer than nonblack patients and that the disparity is more pronounced as illness severity decreases.

Methods: We studied 34143 patient visits in 353 hospital EDs in the National Hospital Ambulatory Medical Care Survey in 2008. In a 2-model approach, we regressed natural logarithmically transformed wait time on the race variable, other patient-level variables, and hospital-level variables for 5 individually stratified illness severity categories. We reported results as percent difference in wait times, with 95% confidence intervals. We used P < .05 for significance level.

Results: On average, black patients experienced significantly longer mean ED wait times than white patients (69.2 vs 53.3 minutes; P < .001). In the multivariate model, black patients did not experience significant different wait times for the 2 most urgent severity categories; black patients experienced increasingly longer waits vs nonblack patients for the 3 least urgent severity categories (14.7%, P < .05; 15.9%, P < .05; 29.9%, P < .001, respectively).

Conclusion: Racial disparity in ED wait times between black and nonblack patients exists, and the size of the disparity is more pronounced as illness severity decreases. We do not find a racial disparity in wait times for critically ill patients.