The risk of emergency department visits in adults living in rural France

Abstract

Abstract Background Individuals living in rural areas have poorer health outcomes due to complex causal pathways related to socio-economic status, health behaviors and lower use of primary care. Emergency department visits without inpatient admission (hereafter ED visits) are an indirect measure of access to primary care. Objective To analyze the determinants of ED visits among French adults living in rural areas. Methods We analyze survey data from the CONSTANCES cohort study, a representative sample of French adults aged 18-69 years. These data on individuals’ demographics, self-reported and physician-reported clinical indicators, and individual socio-economic status, are linked to France’s claims database (SNIIRAM). We analyze the risk of having at least one ED visit, in 2016, using a multivariate logistic regression model. Results Among 12,834 adults included in the study, 1,412 (11%) had at least one ED visit in 2016. After adjustment, the ED visit risk was associated negatively with female gender (OR = 0.87; p < 0.01), age (OR = 0.97; p < 0.01), secondary education (OR = 0.85; p = 0.03), higher use of GPs (OR = 0.99; p = 0.02); and positively associated with the number of comorbidities (OR = 1.1; p < 0.01), poorer self-reported health status (OR = 1.01; p = 0.02), a higher self-reported depression score (OR = 1.01; p = 0.02), and acute care inpatient admissions (OR = 2.4; p < 0.01). Conclusions These results suggest that, among adults living in rural France, those with a lower educational level are at higher risk of ED visits. Policy implications: To reduce health disparities among rural and urban areas, policymakers and primary care professionals should focus on targeted outreach strategies to identify high-needs individuals. Key messages The risk of emergency department visit varies significantly among adult living in rural France. Among adults living in rural France, those with a lower educational level are at higher risk of ED visit.