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. 2025 Jul 24;25(1):975.
doi: 10.1186/s12913-025-13161-2.

Emergency department visits among rural and urban older adults: disparities in ambulatory and emergency care sensitive conditions

Cameron J Gettel  1   2 , Courtney Kitchen  3 , Craig Rothenberg  3 , Yuxiao Song  3 , Ryan Koski-Vacirca  3 , Katherine Schaffer  4 , Alexander T Janke  5   6 , Nicholas M Mohr  7 , Margaret Greenwood-Ericksen  8 , Arjun K Venkatesh  3   9
Affiliations

Emergency department visits among rural and urban older adults: disparities in ambulatory and emergency care sensitive conditions

Cameron J Gettel et al. BMC Health Serv Res. .

Abstract

Background: Older adults in rural geographies may be uniquely vulnerable to difficulty accessing outpatient care, and therefore more reliant on emergency department (ED) care. We compared ED utilization for ambulatory care sensitive conditions (ACSCs) and emergency care sensitive conditions (ECSCs) among rural and urban Medicare beneficiaries.

Methods: We conducted a pooled cross-sectional analysis of 2016-2020 Medicare Current Beneficiary Survey data, assessing ED visitation rates for ACSCs and ECSCs. We present ED visit rates per 100 beneficiary-years and estimated logistic regression models to quantify the odds of having any ED visit, any ACSC-related ED visit, or any ECSC-related ED visit in a given year among older adults in rural and urban areas, adjusting for sociodemographic and health characteristics.

Results: Our sample included 70,830 beneficiary-years, with 17,052 (24.1%) being from beneficiaries residing in rural areas. Rural beneficiaries had higher ED visit rates, with a weighted mean (SD) of 59.2 ED visits (14.1) per 100 beneficiary-years across study years, 11.5 (1.3) for ACSC-related, and 20.6 (3.5) for ECSC-related visits, compared to 43.2 (9.2), 7.2 (0.9), and 15.2 (1.9) ED visits, respectively, for urban beneficiary-years. In adjusted models, rural beneficiaries had a 49% higher odds of having an ED visit (OR: 1.49, 95% CI: 1.40-1.59), a 30% higher odds of an ACSC-related ED visit (OR: 1.30, 95% CI: 1.04-1.64), and a 26% higher odds of an ECSC-related ED visit (OR: 1.26, 95% CI: 1.05-1.50) within a given year when compared to urban counterparts.

Conclusions: Rural Medicare beneficiaries consistently showed higher ED utilization for ACSCs and ECSCs compared to urban beneficiaries, highlighting potential disparities in healthcare access and a need for targeted or policy-based interventions.

Keywords: Ambulatory care sensitive conditions; Emergency care sensitive conditions; Emergency department; Older adults; Rural.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The primary author’s Institutional Review Board determined that this study was exempt secondary research for which patient informed consent was not required. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
ED visit rates for rural and urban Medicare beneficiaries, 2016 to 2020. Abbreviations: ACSC – ambulatory care sensitive condition; ECSC – emergency care sensitive condition
Fig. 2
Fig. 2
Forest plot associations of predictor variables with any ED visits, any ACSC-related ED visits, and any ECSC-related ED visits within a given beneficiary-year. *Note: An example interpretation suggests that beneficiaries residing in rural areas had an OR (CI) of 1.49 (1.39, 1.59) in meeting the outcome of having at least one ED visit within a given year, suggesting they were 49% more likely to have at least one ED visit than those residing in urban areas
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