The association between insurance status and diagnostic imaging for acute abdominal pain among emergency department patients in the United States, 2005–2014

Abstract

Introduction and objectives: Acute abdominal pain (AAP) is one of the most common complaints in the emergency department (ED). Rapid diagnosis is essential and is often achieved through imaging. Computed tomography (CT) is widely considered an exemplary test in the diagnosis of AAP in adult patients. As previous studies show disparities in healthcare treatment based on insurance status, our objective was to assess the association between insurance status and frequency of CT ordered for adult patients presenting to the ED with AAP from 2005 to 2014.

Methods: This study used the National Hospital and Ambulatory Medical Care Survey: Emergency Department Record (NHAMCS) database, which collects data over a randomly assigned 4 week period in the 50 states and DC, to perform an observational retrospective analysis of patients presenting to the ED with AAP. Patients with Medicaid, Medicare or no insurance were compared to patients with private insurance. The association between insurance status and frequency of CT ordered was measured by obtaining odds ratios along with 95% CIs adjusted for age, gender and race/ethnicity.

Results: Individuals receiving Medicaid are 20% less likely to receive CT than those with private insurance (OR 0.8, CI 0.6–0.99, p = .046). Those on Medicare or who are uninsured have no difference in odds of obtaining a CT scan compared to patients with private insurance. Additional findings are that black patients are 42% less likely to receive a CT scan than white patients.

Conclusions and implications: Patients on Medicaid are significantly less likely to receive a CT when presenting to the ED with AAP. Differences in diagnostic care may correlate to inferior health outcomes in patients without private insurance.

Keywords:

• Abdominal pain
• acute abdomen
• CT scan
• diagnostic imaging
• insurance status
• Medicaid
• Medicare

Transparency

Declaration of funding

M Ward-Peterson is currently supported by an NIHMD center grant to the Research Center in Minority Institutions at Florida International University (U54MD012393).

Author contributions

B Roberts, R Courington, E VerHage, and J Lozano were involved in project conception and design. B Roberts, R Courington, E VerHage, and M Ward-Peterson were involved in data analysis. All authors were responsible for drafting and revising the manuscript. All authors approve of the version to be published. All authors agree to be accountable for all aspects of the work.

Declaration of financial/other relationships

The authors and CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

We would like to acknowledge Florida International University and the National Hospital and Ambulatory Medical Care Survey for the use of their data.

Data sharing statement

Data is available indefinitely from the National Hospital and Ambulatory Medical Care Survey: Emergency Department Patient Record (NHAMCS).