title: Socioeconomic factors are associated with frequency of repeat emergency department visits for pediatric closed fractures.
abstract: BACKGROUND
  Previous research has demonstrated both greater difficulty in obtaining follow-up appointments and increased likelihood of return visits to the emergency department (ED) for patients with government-funded insurance plans. The purpose of the current study is to determine whether socioeconomic factors, such as race and insurance type, are associated with the frequency of repeat ED visits in pediatric patients with closed fractures.
  
  
  METHODS
  A review of ED visit data over a 2-year period from a statewide hospital discharge database in New York was conducted. Discharges for patients with a unique person identifier in the database age 17 years and younger were examined for an ICD-9 diagnosis of closed upper or lower extremity fracture. Age, sex, race, and insurance type for patients with a return ED visit within 8 weeks for the same fracture diagnosis were compared with those without a return visit using standard univariate statistical tests and logistic regression analyses.
  
  
  RESULTS
  Of the 68,236 visits reviewed, the revisit rate was 0.85%. Patients of nonwhite or unidentified race were significantly more likely to have a revisit than white patients (OR, 1.27; P=0.006). Patients with government-funded insurance were significantly more likely to have a revisit than those without government-funded insurance (OR, 1.55; P<0.001). Patients with private insurance were significantly less likely to have a revisit than those without private insurance (OR, 0.72; P=0.001).
  
  
  CONCLUSIONS
  Our analysis revealed that nonwhite patients are more likely to return to the ED within 8 weeks for the same fracture diagnosis. Patients with government insurance are 55% more likely to have a revisit, whereas patients with private insurance are 28% less likely to have a revisit. Our results suggest that socioeconomic disparities exist in access to orthopaedic care for closed fractures in a pediatric population. Physicians and policy makers should be mindful of these health care disparities when striving to improve access to care among patients and resource utilization in the ED.
  
  
  METHODS
  Prognostic level II.
authors.affiliation: Hospital for Special Surgery, New York, NY.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Dy
authors.forename: Stephen
authors.initials: S
authors.lastname: Lyman
authors.forename: Huong T
authors.initials: HT
authors.lastname: Do
authors.forename: Peter D
authors.initials: PD
authors.lastname: Fabricant
authors.forename: Robert G
authors.initials: RG
authors.lastname: Marx
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Green
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005596:Fractures, Closed / Q000453:epidemiology*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D009518:New York / Q000453:epidemiology; D009985:Orthopedics / Q000706:statistics & numerical data*; D012008:Recurrence; D012959:Socioeconomic Factors; D014481:United States