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. 2025 Aug 8;20(8):e0329376.
doi: 10.1371/journal.pone.0329376. eCollection 2025.

Racial/Ethnic differences in emergency department triage assignment among visits for substance use

Samantha Goldfarb  1 , Natalie Dix  1 , Austin Spitz  1 , Katelyn Graves  1 , Megan Deichen Hansen  1 , Shermeeka Hogans-Mathews  2 , Jessica Day  1 , Jeffrey Harman  1
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Racial/Ethnic differences in emergency department triage assignment among visits for substance use

Samantha Goldfarb et al. PLoS One. .

Abstract

Background: The opioid/substance use disorder (SUD) epidemic in the United States has become a public health crisis. Stigma by health care workers towards patients with SUD has been identified as a barrier to treatment. Additionally, racial inequities in wait times and service provision have been found in Emergency Departments (EDs).

Objective: The purpose of this study was to examine the racial/ethnic differences in severity of ED triage assignment among visits for SUD.

Methods: This retrospective study utilized pooled data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2016-20. The dependent variable was the recorded triage level for patients with SUD. The independent variable was patient race/ethnicity. Analyses controlled for variables such as age, sex, and arrival by ambulance. Differences in triage level by race/ethnicity among visits by patients with SUD was assessed via multivariable logistic regression models.

Results: Of the reported 788 SUD-specific ED visits from patients with SUD, 56.0% were non-Hispanic White, 28.6% were non-Hispanic Black, 12.9% were Hispanic, and 2.5% were of another race. Visits by Black patients with SUD had 53% lower odds of being assigned to an immediate/emergent triage level compared to visits by White patients with SUD (OR=0.47, p = .025).

Conclusion: We found that visits by Black patients with SUD were associated with lower odds of receiving an immediate/emergent triage assignment compared to visits by White patients with SUD, after adjusting for confounding variables. Our results suggest potential dual stigma in ED care of being Black and having a substance use disorder.

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Conflict of interest statement

The authors have declared that no competing interests exist.

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