Healthc Inform Res.  2020 Jan;26(1):34-41. 10.4258/hir.2020.26.1.34.

Big Data-Driven Approach for Health Inequalities in Foreign Patients with Injuries Visiting Emergency Rooms

Affiliations
  • 1Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. d2seo@ucsd.edu
  • 2Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 3Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 4National Emergency Medical Center, Seoul, Korea.
  • 5Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 6UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA.

Abstract


OBJECTIVES
Foreign patients are more likely to receive inappropriate health service in the emergency room. This study aimed to investigate whether there is health inequality between foreigners and natives who visited emergency rooms with injuries and to examine its causes.
METHODS
We analyzed clinical data from the National Emergency Department Information System database associated with patients of all age groups visiting the emergency room from 2013 to 2015. We analyzed data regarding mortality, intensive care unit admission, emergency operation, severity, area, and transfer ratio.
RESULTS
A total of 4,464,603 cases of injured patients were included, of whom 67,683 were foreign. Injury cases per 100,000 population per year were 2,960.5 for native patients and 1,659.8 for foreign patients. Foreigners were more likely to have no insurance (3.1% vs. 32.0%, p < 0.001). Serious outcomes (intensive care unit admission, emergency operation, or death) were more frequent among foreigners. In rural areas, the difference between serious outcomes for foreigners compared to natives was greater (3.7% for natives vs. 5.0% for foreigners, p < 0.001). The adjusted odds ratio for serious outcomes for foreign nationals was 1.412 (95% confidence interval [CI], 1.336-1.492), and that for lack of insurance was 1.354 (95% CI, 1.314-1.394).
CONCLUSIONS
Injured foreigners might more frequently suffer serious outcomes, and health inequality was greater in rural areas than in urban areas. Foreign nationality itself and lack of insurance could adversely affect medical outcomes.

Keyword

Wounds and Injuries; Healthcare Disparities; Emigrants and Immigrants

MeSH Terms

Emergencies*
Emergency Service, Hospital*
Emigrants and Immigrants
Ethnic Groups
Health Services
Healthcare Disparities
Humans
Information Systems
Insurance
Intensive Care Units
Mortality
Odds Ratio
Population Groups
Socioeconomic Factors*
Wounds and Injuries
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