title: Presentation to Emergency Departments for Acute Rhinosinusitis: Disparities in Symptoms by Race and Insurance Status.
abstract: Medicaid and self-pay insurance statuses and race are associated with emergency department (ED) presentation for uncomplicated acute rhinosinusitis (ARS). We investigated whether ARS symptomatology could explain this disproportionate ED use.
  
  
  
  2006-2010 National Hospital Ambulatory Medical Care Surveys.
  
  
  
  EDs in the United States.
  
  
  
  The data comprise 1,632,826 adult visits for uncomplicated ARS at hospital EDs. Patient-reported reasons for presentation included constitutional symptoms, facial pain or headache, sinonasal symptoms, head cold or flu-like symptoms, cough or sputum production, and sore throat. Patient-reported pain level was also included. Symptoms were assessed for associations with insurance status and race after controlling for clinical, demographic, and socioeconomic characteristics.
  
  
  
  Medicaid patients had similar symptomatology and levels of pain when compared with privately insured patients. Self-pay patients reported higher pain levels (P = .033) and were less likely to report head cold or flu-like symptoms (P = .018) but were equally likely to report other symptomatology. Relative to white patients, Hispanic patients were more likely to complain of facial pain and headaches (P = .033) and less likely to complain of other classical ARS symptoms, such as cough or sputum production (P = .013), sinonasal symptoms (P = .019), or head cold or flu-like symptoms (P = .019). Black patients were also less likely to complain of sinonasal symptoms (P = .038).
  
  
  
  Symptomatology does not explain disproportionate ED use for ARS by Medicaid patients, while higher self-reported pain levels may explain self-pay patients' disproportionate ED utilization. Likewise, ED presentation for ARS among Hispanic patients may be related to symptomatology that is less specific for ARS, such as headache and facial pain.
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA regan_bergmark@meei.harvard.edu.
authors.forename: Regan W
authors.initials: RW
authors.lastname: Bergmark
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ahmad R
authors.initials: AR
authors.lastname: Sedaghat
mesh_terms: D000208:Acute Disease; D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D010147:Pain Measurement; D012220:Rhinitis / Q000208:ethnology* / Q000628:therapy*; D012852:Sinusitis / Q000208:ethnology* / Q000628:therapy*; D014481:United States
keywords: ambulatory care sensitive conditions; emergency service; ethnicity; health care delivery; health care disparities; hospital; insurance; pain; race; sinusitis; socioeconomic factors; symptoms