Associations of Patient Race and Ethnicity With Emergency Department Disposition for Mental Health Visits in the United States

Abstract

Objective: To describe associations between patient race and ethnicity with emergency department disposition for mental health visits in the United States.

Methods: We identified 674,821 visits for mental health in the 2019 National Emergency Department Sample and classified them by ICD-10 diagnostic group: schizophrenia-spectrum, bipolar, major depressive, anxiety, or other disorders. Racial and ethnic categories were White, Black, Hispanic, or other. Logistic regression models, adjusted for age, sex, insurance status, and medical comorbidities, were used to describe differences in odds of inpatient admission by race/ethnicity and diagnosis.

Results: After covariate adjustment, we did not find overall differences in the likelihood of admission between racial/ethnic groups. However, compared to White patients, admission rates were lower for visits by Black patients for bipolar disorder (OR = 0.71; 95% CI, 0.59-0.84) and major depressive disorder (OR = 0.70; 95% CI, 0.59-0.83) and lower for Hispanic patients (OR = 0.57; 95% CI, 0.47-0.68) for anxiety disorders. There were no significant racial/ethnic differences in admission rates for schizophrenia-spectrum disorders.

Conclusions: Overall admission rates were comparable for Black and White patients. After covariate adjustment, there were no differences across racial/ethnic groups, though some racial/ethnic differences persisted within diagnostic subsets of mood and anxiety disorders.

Figure 1.. ED mental health visits by primary diagnosis group and race/ethnicity, United States, 2019.

National Emergency Department Sample, 2019, analysis limited to those age 18–90 years. Results based on weighted sampling. Percentages in diagnostic group graphs do not sum to 100 due to missing data values for race/ethnicity (1.8% of total sample). Abbreviations. ANX=anxiety disorders, BPD=bipolar disorder, MDD=major depressive disorder, Oth dx=other diagnoses, SCZ=schizophrenia-spectrum diagnoses.

Figure 2.. Admission rates for mental health ED visits, by diagnosis group and race/ethnicity.

National Emergency Department Sample, 2019, analysis limited to those age 18–90 years. N=674,821. 95% confidence interval given by error bars. Percentages based on weighted sampling. Independent F-tests for differences between rates of admission by racial/ethnic group within diagnostic category were inclusive of White, Black, Hispanic, and other race/ethnicity (not shown); omnibus p-values displayed above diagnostic category groups. Abbreviations. ANX=anxiety disorders, BPD=bipolar disorder, MDD=major depressive disorder, Oth dx=other diagnoses, SCZ=schizophrenia-spectrum diagnoses.