Trends in Emergency Department Visits Among People Younger Than Age 65 by Insurance Status: United States, 2010-2021.

Purpose-This report describes trends in emergency department visits among people younger than age 65 from 2010 through 2021, by health insurance status and selected demographic and hospital characteristics. Methods-Estimates in this report are based on data collected in the 2010-2021 National Hospital Ambulatory Medical Care Survey. Data were weighted to produce annual national estimates. Patient and hospital characteristics are presented by primary expected source of payment. Results-Private insurance and Medicaid were the most common primary expected sources of payment at emergency department visits by people younger than age 65 from 2010 through 2013. Medicaid was the most common primary expected source of payment from 2014 through 2021. Among children younger than age 18 years, the most common primary expected source of payment was Medicaid across the entire period. The percentage of visits by children with no insurance decreased from 7.4% in 2010 to 3.0% in 2021. Among adults, the percentage of visits with Medicaid increased from 25.5% in 2010 to 38.9% in 2021, and the percentage of visits by those with no insurance decreased from 24.6% to 11.1% during this period. Among Black non-Hispanic and Hispanic people, Medicaid was the most frequent primary expected source of payment during the entire period. Among White non-Hispanic people, private insurance was the most frequent primary expected source of payment through 2015, while private insurance and Medicaid were the most frequent primary expected sources of payment from 2016 through 2021.

Emergency Department Visit Rates by Selected Characteristics: United States, 2021.

In 2021, 140 million emergency department (ED) visits occurred in the United States (1). During that year, about 4% of children had two or more ED visits in the past 12 months, and 18% of adults had visited the ED in the past 12 months (2,3). This report presents characteristics of ED visits by age group, sex, race and ethnicity, insurance, and mentions of COVID-19, using data from the 2021 National Hospital Ambulatory Medical Care Survey (NHAMCS) (4).

Emergency Department Visits Among Children Aged 0-17 by Selected Characteristics: United States, 2019-2020.

With the disruptions to access and use of care caused by the COVID-19 pandemic, emergency department (ED) visit rates decreased from 2019 to 2020 among children and adolescents (1). The ED visit rate for children under age 1 year in 2020 was nearly one-half of the rate in 2019, and the rate for those aged 1-17 years decreased over the same period (2). This report uses data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) (3,4) to compare ED visits for children aged 0-17 from 2019 to 2020, by age group, sex, and race and ethnicity, and to assess changes in wait time at ED visits.

Emergency Department Visits With Suicidal Ideation: United States, 2016- 2020.

Before the COVID-19 pandemic in the United States, suicide was the 10th highest cause of death overall and the 2nd highest cause for the 10-34 age group (1,2). Suicidal ideation is defined as thinking about, considering, or planning suicide; is predictive of suicide deaths; and may result in injury and hospitalization (3). An estimated 4.0% to 4.8% of adults aged 18 and over have suicidal ideation each year (4,5). The lifetime prevalence of suicidal ideation in the United States is 15.6% (6). This report uses data from the 2016-2020 National Hospital Ambulatory Medical Care Survey to present the annual average emergency department (ED) visit rate per 10,000 people for patients with suicidal ideation.

Emergency Department Visit Rates by Adults With Diabetes: United States, 2020-2021.

In 2021, diabetes was the eighth leading cause of death in the United States (1). Over 37 million Americans have diabetes (2). While it most often develops in people older than age 45 (3), its frequency is increasing in young adults (4). Among people with diabetes, increasing age is a risk factor for hospitalization (5). Emergency department (ED) visits by people with diabetes have been used to monitor access to care and healthcare use (6). This report describes ED visits made by adults with diabetes, and presents selected characteristics by age.

Emergency Department Visit Rates by Selected Characteristics: United States, 2020.

In 2020, an estimated 131 million emergency department (ED) visits occurred in the United States, with 19.0% of adults reporting a visit and 4.7% of children reporting two or more visits in the past 12 months (1-3). In that time, over 20 million cases of COVID-19 caused a disruption in access to and use of care (4). This report presents characteristics of ED visits, including those with mentions of COVID-19, by age group, sex, race and ethnicity, and primary expected source of payment, using data from the 2020 National Hospital Ambulatory Medical Care Survey (NHAMCS)(5).

Emergency Department Visits by Adults With Chronic Conditions Associated With Severe COVID-19 Illness: United States, 2017-2019.

Objective-This report describes emergency department (ED) visits made by adults with selected chronic conditions associated with severe COVID-19 illness.

Characteristics of Visits to Health Centers: United States, 2020.

Health centers provide comprehensive medical care in medically underserved communities (1). The number of health centers has expanded in the last decade from 1,124 sites in 2010 to 1,375 sites in 2020 (2,3). In 2020, nearly 29 million people received medical care from health centers regardless of their insurance status or ability to pay for care (3). This report examines health center visit rates by various characteristics, like age, sex, insurance status, reason for visit, and services, using data from the 2020 National Ambulatory Medical Care Survey-Community Health Centers (NAMCS-CHC).

Emergency Department Visit Rates by Selected Characteristics: United States, 2019.

In 2019, an estimated 151 million emergency department (ED) visits occurred in the United States and about 22% of adults aged 18 and over had visited the ED in the past 12 months (1,2). This report presents ED visit rates by selected characteristics, including metropolitan statistical area (MSA) status, age, sex, race and ethnicity, and health insurance status. Data for this report are from the National Hospital Ambulatory Medical Care Survey (NHAMCS), an annual nationally representative survey of nonfederal, general, and short-stay hospitals (3,4).

National Hospital Care Survey Demonstration Projects: Examination of Inpatient Hospitalization and Risk of Mortality Among Patients Diagnosed With Pneumonia.

Objective-This report demonstrates the ability of data from the National Hospital Care Survey (NHCS) linked to the National Death Index (NDI) to provide information on inpatient hospitalizations and in-hospital and post-acute mortality among patients hospitalized for a specific condition, in this case pneumonia.

Characteristics of Office-based Physician Visits, 2018.

In 2018, 85% of adults and 96% of children in the United States had a usual place to receive health care (1,2). Most children and adults listed a doctor's office as the usual place they received care (1,2). In 2018, an estimated 860.4 million office-based physician visits occurred in the United States (3,4). This report examines visit rates by age and sex. It also examines visit characteristics-including insurance status, reason for visit, and services- by age using data from the 2018 National Ambulatory Medical Care Survey (NAMCS).

Emergency Department Visits for Influenza and Pneumonia: United States, 2016-2018.

In the United States, there were an estimated 810,000 hospitalizations attributable to influenza during 2017-2018 (1). Pneumonia is the most common respiratory complication of influenza (2). In 2019, the ninth leading cause of death was influenza and pneumonia and the death rate was 15.2 per 100,000 persons, ranging from 4.1 for infants aged under 1 year to 294.7 for adults aged 85 and over (3,4). This report describes emergency department (ED) visit rates for patients with influenza and pneumonia (either influenza or pneumonia, or both) by selected patient characteristics.

Emergency Department Visit Rates by Selected Characteristics: United States, 2018.

In 2018, there were an estimated 130 million emergency department (ED) visits in the United States (1). In 2019, approximately 22% of adults aged 18 and over had visited the ED in the past 12 months (2). This report presents ED visit rates by selected characteristics, including metropolitan statistical area (MSA), age, sex, race and ethnicity, and health insurance status. Data for this report are from the National Hospital Ambulatory Medical Care Survey (NHAMCS) (3,4).

Respiratory Illness Emergency Department Visits in the National Hospital Care Survey and the National Hospital Ambulatory Medical Care Survey.

Purpose-This report compares emergency department (ED) visits for respiratory illness between the 2014 National Hospital Care Survey (NHCS) and the 2014 National Hospital Ambulatory Medical Care Survey (NHAMCS) to determine the potential of researching respiratory illness in EDs with non-nationally representative NHCS data. The 2014 NHCS data linked to records in the 2014-2015 National Death Index (NDI) are also described to provide results on mortality after ED visits for respiratory illness. Methods-For both surveys, encounters with respiratory illness were identified using diagnosis codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Weighted NHAMCS percentage estimates and their 95% confidence intervals (CIs) are shown for all demographic characteristics. Unweighted NHCS percentages are presented for all demographic and health care characteristics and are compared with weighted NHAMCS percentage estimates and used to report NHCS-only results. Standard errors and CIs are also presented for the NHCS unweighted percentages as a measure of variability. Results-The percentage of NHCS ED visits for respiratory illness fell within NHAMCS measures of statistical variation for overall and specific respiratory illnesses. Additionally, respiratory illness by sex, older age groups, older men, and female patients of all ages fell within these measures. Compared with NHAMCS, NHCS had a higher percentage of ED visits for respiratory illness for both infants (under 1 year) and children (1-17 years) but a lower percentage for adults aged 18-44. NHCS data show that 15.2% of patients with ED visits for respiratory illness were hospitalized and of those hospitalized, 6.6% died within 90 days post-discharge. However, 11.1% of patients admitted to the intensive care unit died within 90 days. Conclusion-Although the 2014 NHCS data are not nationally representative, the data may be used for exploratory analyses and have analytical capabilities that are not available in other hospital surveys.

Safety and immunogenicity of the adjunct therapeutic vaccine ID93 + GLA-SE in adults who have completed treatment for tuberculosis: a randomised, double-blind, placebo-controlled, phase 2a trial.

BACKGROUND: A therapeutic vaccine that prevents recurrent tuberculosis would be a major advance in the development of shorter treatment regimens. We aimed to assess the safety and immunogenicity of the ID93 + GLA-SE vaccine at various doses and injection schedules in patients with previously treated tuberculosis. METHODS: This randomised, double-blind, placebo-controlled, phase 2a trial was conducted at three clinical sites near Cape Town, South Africa. Patients were recruited at local clinics after receiving 4 months of tuberculosis treatment, and screened for eligibility after providing written informed consent. Participants were aged 18-60 years, BCG-vaccinated, HIV-uninfected, and diagnosed with drug-sensitive pulmonary tuberculosis. Eligible patients had completed standard treatment for pulmonary tuberculosis in the past 28 days. Participants were enrolled after completing standard treatment and randomly assigned sequentially to receive vaccine or placebo in three cohorts: 2 µg intramuscular ID93 + 2 µg GLA-SE on days 0 and 56 (cohort 1); 10 µg ID93 + 2 µg GLA-SE on days 0 and 56 (cohort 2); 2 µg ID93 + 5 µg GLA-SE on days 0 and 56 and placebo on day 28 (cohort 3); 2 µg ID93 + 5 µg GLA-SE on days 0, 28, and 56 (cohort 3); or placebo on days 0 and 56 (cohorts 1 and 2), with the placebo group for cohort 3 receiving an additional injection on day 28. Randomisation was in a ratio of 3:1 for ID93 + GLA-SE and saline placebo in cohorts 1 and 2, and in a ratio of 3:3:1 for (2 ×) ID93 + GLA-SE, (3 ×) ID93 + GLA-SE, and placebo in cohort 3. The primary outcomes were safety and immunogenicity (vaccine-specific antibody response and T-cell response). For the safety outcome, participants were observed for 30 min after each injection, injection site reactions and systemic adverse events were monitored until day 84, and serious adverse events and adverse events of special interest were monitored for 6 months after the last injection. Vaccine-specific antibody responses were measured by serum ELISA, and T-cell responses after stimulation with vaccine antigens were measured in cryopreserved peripheral blood mononuclear cells specimens using intracellular cytokine staining followed by flow cytometry. This study is registered with ClinicalTrials.gov, number NCT02465216. FINDINGS: Between June 17, 2015, and May 30, 2016, we assessed 177 patients for inclusion. 61 eligible patients were randomly assigned to receive: saline placebo (n=5) or (2 ×) 2 µg ID93 + 2 µg GLA-SE (n=15) on days 0 and 56 (cohort 1); saline placebo (n=2) or (2 ×) 10 µg ID93 + 2 µg GLA-SE (n=5) on days 0 and 56 (cohort 2); saline placebo (n=5) on days 0, 28 and 56, or 2 µg ID93 + 5 µg GLA-SE (n=15) on days 0 and 56 and placebo injection on day 28, or (3 ×) 2 µg ID93 + 5 µg GLA-SE (n=14) on days 0, 28, and 56 (cohort 3). ID93 + GLA-SE induced robust and durable antibody responses and specific, polyfunctional CD4 T-cell responses to vaccine antigens. Two injections of the 2 µg ID93 + 5 µg GLA-SE dose induced antigen-specific IgG and CD4 T-cell responses that were significantly higher than those with placebo and persisted for the 6-month study duration. Mild to moderate injection site pain was reported after vaccination across all dose combinations, and induration and erythema in patients given 2 µg ID93 + 5 µg GLA-SE in two or three doses. One participant had grade 3 erythema and induration at the injection site. No vaccine-related serious adverse events were observed. INTERPRETATION: Vaccination with ID93 + GLA-SE was safe and immunogenic for all tested regimens. These data support further evaluation of ID93 + GLA-SE in therapeutic vaccination strategies to improve tuberculosis treatment outcomes. FUNDING: Wellcome Trust (102028/Z/13/Z).

Emergency Department Visits Among Adults Aged 60 and Over: United States, 2014-2017.

In the United States, the number of older adults is increasing. From 2007 to 2017, the number of adults aged 60 and over increased from 52 million to 71 million, and during the same time period, the share of the U.S. population comprising older adults also increased from 17% to 22% (1,2). During 2014-2017, 20% of all emergency department (ED) visits in the United States were made by patients aged 60 and over, representing an annual average of approximately 29 million ED visits (3-6). Given their growing proportion of the population, older individuals will make up an increasingly larger share of ED visits in the coming years. This report describes ED visits made by adults aged 60 and over, assessing selected characteristics by age.

Trends in Opioids Prescribed at Discharge From Emergency Departments Among Adults: United States, 2006-2017.

Objective-This report describes trends in opioid prescribing at emergency department (ED) discharge among adults from 2006-2007 through 2016-2017, by selected patient and hospital characteristics and the type of opioids prescribed. Methods-Data are from the 2006-2017 National Hospital Ambulatory Medical Care Survey. The study population included all ED visits by patients aged 18 and over. The main outcome studied was opioids prescribed at ED discharge, defined using Cerner Multum's third-level therapeutic category codes for narcotic analgesics (Code 60) and narcotic-analgesic combinations (Code 191). Results-The percentage of ED visits by adults with opioids prescribed at discharge increased from 2006-2007 (19.0%) through 2010-2011 (21.5%) and then decreased from 2010-2011 through 2016-2017 (14.6%). The rate of decrease was highest among visits by younger adults aged 18-44 (from 25.5% in 2010-2011 to 15.3% in 2016-2017) and those living in medium or small metropolitan counties (24.3% in 2010-2011 to 14.5% in 2016-2017). The percentage of visits with morphine-equivalent opioids prescribed increased from 2006-2007 (11.3%) through 2010-2011 (12.4%) and decreased from 2010-2011 through 2016-2017 (6.7%). The percentage of visits with stronger than morphine opioids prescribed similarly increased from 2006-2007 (3.8%) through 2010-2011 (5.5%) and decreased to 3.0% in 2016-2017. In contrast, the percentage of visits with weaker than morphine opioids prescribed decreased from 4.0% in 2006-2007 through 3.6% in 2010-2011 and increased to 5.0% in 2016-2017. Among all opioids prescribed at discharge, the percentage with acetaminophen-hydrocodone prescribed decreased from 53.1% in 2012-2013 to 41.5% in 2016-2017, with a corresponding increase for both tramadol and acetaminophen-codeine. Top diagnoses associated with an opioid prescribed at discharge included dental pain, urolithiasis (stones in the kidney, bladder, or urinary tract), fracture injuries, back pain, and extremity pain. For all top diagnoses, the percentage of visits with an opioid prescribed decreased from 2010-2011 through 2016-2017, though the decrease was not statistically significant for urolithiasis.

Physician Office Visits at Which Benzodiazepines Were Prescribed: Findings From 2014-2016 National Ambulatory Medical Care Survey.

Objective-This report describes characteristics of visits to office-based physicians at which benzodiazepines were prescribed, including visits where opioids were coprescribed. Methods-Data from the 2014-2016 National Ambulatory Medical Care Survey were used. Population-based visit rates were examined by select patient characteristics. Visit characteristics are also presented. Results-During 2014-2016, the rate of visits at which benzodiazepines were prescribed was 27 annual visits per 100 adults. Among visits at which benzodiazepines were prescribed, approximately one-third involved an overlapping opioid prescription for a rate of 10 annual visits per 100 adults. Both visit rates were higher for women than men and increased with age. The percentage of visits with a new prescription for a benzodiazepine or a new prescription for both a benzodiazepine and an opioid was lower than the percentage of visits with continued prescriptions. A problem related to a chronic condition was the most common reason for visits at which benzodiazepines were prescribed, as well as for visits at which benzodiazepines were coprescribed with opioids. Mental disorders were the most frequent primary diagnosis category for visits at which benzodiazepines were prescribed, whereas diseases of the musculoskeletal system and connective tissue was the most frequent primary diagnosis category for visits at which benzodiazepines were coprescribed with opioids.

Antineoplastic drugs prescription during visits by adult cancer patients with comorbidities: findings from the 2010-2016 National Ambulatory Medical Care Survey.

PURPOSE: Cancer treatment may be affected by comorbidities; however, studies are limited. The purpose of this study is to examine the frequency of comorbidities at visits by patients with breast, prostate, colorectal, and lung cancer and to estimate frequency of a prescription for antineoplastic drugs being included in the treatment received at visits by patients with cancer and concomitant comorbidities. METHODS: We used nationally representative data on visits to office-based physicians from the 2010-2016 National Ambulatory Medical Care Survey and selected visits by adults with breast, prostate, colorectal, or lung cancer (n = 4,672). Nineteen comorbid conditions were examined. Descriptive statistics were calculated for visits by cancer patients with 0, 1, and ≥ 2 comorbidities. RESULTS: From 2010-2016, a total of 10.2 million physician office visits were made annually by adult patients with breast, prostate, colorectal, or lung cancer. Among US visits by adult patients with breast, prostate, colorectal, or lung cancer, 56.3% were by patients with ≥ 1 comorbidity. Hypertension was the most frequently observed comorbidity (37.7%), followed by hyperlipidemia (19.0%) and diabetes (12.3%). Antineoplastic drugs were prescribed in 33.5% of the visits and prescribed at a lower percentage among visits by cancer patients with COPD (21.3% versus 34.3% of visits by cancer patients without COPD) and heart disease (22.7% versus 34.2% of visits by cancer patients without heart disease). CONCLUSION: Our study provides information about comorbidities in cancer patients being treated by office-based physicians in an ambulatory setting.