title: Emergency Department Use in the US-Mexico Border Region and Violence in Mexico: Is There a Relationship?
abstract: OBJECTIVE
  This study assessed the association between homicide rates in northern Mexico and potentially avoidable use of emergency departments (ED) in the US-Mexico border region. The border region is largely rural and underserved, making the identification and correction of potential barriers to access crucial.
  
  
  METHODS
  We used secondary data from state inpatient and ED discharge databases for California and Arizona for 2005-2010. A retrospective observational analysis using generalized linear models was used to determine whether the probability that an ED encounter was potentially avoidable was associated with homicide rates in the nearest Mexican municipality. To conduct the analysis, the location of ED encounters were identified and matched with homicide rates in the nearest Mexican municipality and regional characteristics. The probability that an ED encounter was potentially avoidable was calculated using the Billings ED algorithm.
  
  
  RESULTS
  We found that 77% of ED encounters were potentially avoidable, with a higher percentage in border counties. There was no statistically significant relationship between homicide rates and the probability that an ED encounter was for a potentially avoidable condition for the full analytic sample (n = 24,859,273) and the uninsured and underinsured in the sample (n = 11,700,123).
  
  
  CONCLUSIONS
  A substantial majority of ED encounters in the US-Mexico border region were potentially avoidable. However, there was not a strong relationship between homicide rates in northern Mexico and the distribution of ED discharges in Arizona and California. Given the large percentage of potentially avoidable ED encounters and the ongoing violence in Mexico, continuing to monitor this relationship is important.
authors.affiliation: Department of Markets, Public Policy, and Law, Boston University School of Management, Boston, Massachusetts.|Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Kimberley H
authors.initials: KH
authors.lastname: Geissler
authors.affiliation: North Carolina Rural Health Research Program, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, North Carolina.
authors.forename: George M
authors.initials: GM
authors.lastname: Holmes
mesh_terms: D019548:Crime Victims / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008800:Mexico; D012189:Retrospective Studies; D019035:Rural Health Services / Q000706:statistics & numerical data*; D014481:United States; D014754:Violence / Q000706:statistics & numerical data*
keywords: US-Mexico border region; access to care; emergency department utilization; medically underserved areas; social determinants of health