Patterns of Emergency Department Utilization Among Persons with Multiple Sclerosis across Seven Medical Institutions

Background.Persons with multiple sclerosis (MS) rely heavily on the emergency department (ED) for acute care, with marginalized populations bearing an unequal MS burden of disease.Understanding how social determinants of health influence ED utilization is crucial for optimizing MS management.Objectives.Examine the relationship between ED utilization, race, insurance type, and the Distressed Communities Index in patients with MS.Methods.We analyzed encounters from seven healthcare institutions in the Chicago Area Patient-Centered Outcomes Research Network.Differences in ED utilization across patient groups were assessed using Chisquare tests and risk ratios for each characteristic combination investigated.Results.The sample included 217,184 encounters from 12,770 patients between 2015 and 2021.Each factor had a statistically significant relationship with ED utilization.Increased ED utilization was associated with living in At risk or Distressed neighborhoods, being Black or Hispanic, lacking private insurance, and not having prior neurology encounters.Combined, these factors resulted in over three times the relative risk of ED encounters compared to White patients with private insurance living in more affluent areas who saw a neurologist (risk ratio 3.57, 95% CI [3.12, 4.08]).Conclusions.These findings can guide efforts to address systemic inequities, and individual healthcare needs to improve MS management.