Burden of Emergency Department Visits and Their Outcomes Among Patients With Rheumatoid Arthritis: Insights From the Nationwide Emergency Department Sample

Abstract

Objective: Patients with rheumatoid arthritis (RA) frequently visit emergency departments (EDs), but their clinical characteristics and admission factors are poorly understood. Our study investigates the epidemiology and outcomes of ED visits among patients with RA using the Nationwide Emergency Department Sample (NEDS).

Methods: This cross-sectional study used the 2019 NEDS data to identify RA-related ED visits using International Classification of Disease, Tenth Revision codes M05.X or M06.X. RA-related ED visits were defined as encounters in which RA was recorded in any diagnostic position. Demographics, clinical features, and comorbidities were compared between RA and non-RA ED visits. Racial variations were assessed, and multivariable logistic regression identified factors associated with inpatient admission.

Results: We identified 905,811 (0.8%) ED visits for adults aged ≥18 years with RA. Compared to non-RA visits, RA ED visits had a higher proportion of patients aged ≥65 years, women, White patients, and Medicare-insured individuals with a greater comorbidity burden. Admission rates were 46% for RA visits versus 16% for non-RA visits. Black and Hispanic patients with RA were younger than White patients and more likely to belong to the lowest income quartile. Older age, male sex, and comorbidities were associated with higher admission odds, whereas Black race, lowest income quartile, and Medicaid coverage correlated with lower odds of admission. Septicemia was the most common primary ED diagnosis in patients with RA.

Conclusion: Patients with RA visiting the ED were older, had a higher comorbidity burden, and were three times more likely to be admitted than patients without RA. Black patients and those in the lowest income quartile had lower odds of admission, highlighting potential disparities and the need for targeted interventions to improve health equity.

Figure 1

Multivariable analysis of baseline demographic characteristics and clinical comorbidities associated with inpatient admission after emergency department visits in patients with rheumatoid arthritis: Nationwide Emergency Department Sample, 2019. OR was adjusted for age, sex, race, primary payer, income quartile, and baseline clinical comorbidities. CI, confidence interval; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; OR, odds ratio; PI, Pacific Islander.