Socioeconomic disparities in the complexity of hernias evaluated at Emergency Departments across the United States

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Background: Hernias represent one of the most common surgical conditions with a high-burden on health expenditures. We examined the impact of socioeconomic-status and complexity of presentation among patients in the Emergency Department (ED). Methods: Retrospective analysis of 2006–2014 data from the Nationwide Emergency Department Sample, identified adult discharges with a diagnosis of inguinal, femoral, and umbilical hernia. Cases were dichotomized: complicated and uncomplicated. Unadjusted and adjusted analyses were used to determine factors that influence ED presentation. Results: Among 264,484 patients included, 73% presented as uncomplicated hernias and were evaluated at urban hospitals (86%). Uncomplicated presentation was more likely in Medicaid (OR 1.56 95%CI1.50–1.61) and uninsured (OR 1.73 95%CI 1.67–1.78), but less likely for patients within the third and fourth MHI quartile (OR 0.82 95%CI 0.80–0.84 and OR 0.77 95%CI 0.75–0.79), respectively. Conclusion: Uninsured, publicly-insured, and low-MHI patients were more likely to present to ED with uncomplicated hernias. This finding might reflect a lack of access to primary surgical care for non-urgent surgical diseases.

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