Researchers from the University of California, Irvine found that undocumented Latino patients’ emergency department utilization saw a dramatic decrease during the three months following the initial stay-at-home orders and the public charge rule change in response to the COVID-19 pandemic – even more than their documented Latino patient counterparts.
Nationally, emergency department (ED) usage plummeted roughly 42 percent from March to April 2020 compared to the same period in 2019. The UC Irvine team set out to determine the decline specific to Los Angeles County, which is home to nearly 880,000 undocumented immigrants and has the second largest health system of any county in the U.S.
If emergency departments’ avoidance continues as the COVID-19 pandemic evolves, local groups and care organizations could expand outreach efforts to undocumented populations to ensure their continuity of care in other settings, such as outpatient care.”
– Annie Ro, PhD, Associate Professor of Health, Society, & Behavior
Utilizing medical records from the LAC+USC Medical Center from January 2018 to September 2020, the researchers compared records of more than 230,000 emergency visits and aggregated data by race/ethnicity and health insurance status. The team used a “time-series” approach, a common method for analyzing data during the pandemic that accounts for seasonal trends in ED utilization in pre-pandemic patterns. Their analysis revealed a roughly 10% drop in ED utilization compared to expected levels.
Findings are published in the Journal of Racial and Ethnic Health Disparities.
Researchers suspect their findings may underestimate the reduction among undocumented patients in other parts of the country, as the safety-set system in Los Angeles is relatively robust. While all Latino patients saw a reduction in ED visits during the earliest days of the pandemic, undocumented Latinos saw the largest drop. This may be due to immigration concerns, as the start of the pandemic coincided with the start of the new public charge rule change, which barred immigrants from receiving green cards if they received some public benefits.
The team also observed that the drop in emergency department use among undocumented immigrants seemed to extend even beyond the initial nine-week stay-at-home orders, which suggests that this prolonged decline lasted at least through the fall of 2020.
“Health care institutions and local policy efforts could work to ensure that hospitals are safe spaces for undocumented immigrants to receive care without concerns over their immigration status,” said corresponding author Annie Ro, PhD, associate professor of health, society, and behavior, with the UCI Program in Public Health. “If emergency departments’ avoidance continues as the COVID-19 pandemic evolves, local groups and care organizations could expand outreach efforts to undocumented populations to ensure their continuity of care in other settings, such as outpatient care.”
This study was funded in part by the UCI CRAFT-COVID Committee.
Additional authors who contributed to this study include Tim Bruckner, PhD, professor of health, society, and behavior, and Michael Huynh, PhD student, both with the UCI Program in Public Health; Senxi Du, MPH, MD, and Andrew Young, associate professor of medicine, both with the Keck School of Medicine of USC.
