The association between insurance status and diagnostic imaging for acute abdominal pain among emergency department patients in the United States, 2005-2014.

INTRODUCTION AND OBJECTIVES: Acute abdominal pain (AAP) is one of the most common complaints in the emergency department (ED). Rapid diagnosis is essential and is often achieved through imaging. Computed tomography (CT) is widely considered an exemplary test in the diagnosis of AAP in adult patients. As previous studies show disparities in healthcare treatment based on insurance status, our objective was to assess the association between insurance status and frequency of CT ordered for adult patients presenting to the ED with AAP from 2005-2014.

METHODS: This study used the National Hospital and Ambulatory Medical Care Survey: Emergency Department Record (NHAMCS) database, which collects data over a randomly-assigned four-week period in the 50 states and DC, to perform an observational retrospective analysis of patients presenting to the ED with AAP. Patients with Medicaid, Medicare, or no insurance were compared to patients with private insurance. The association between insurance status and frequency of CT ordered was measured by obtaining odds ratios along with 95% CIs adjusted for age, gender, and race/ethnicity.

RESULTS: Individuals receiving Medicaid are 20% less likely to receive CT than those with private insurance (OR 0.8, CI 0.6-0.99, p = 0.046). Those on Medicare or who are uninsured have no difference in odds of obtaining a CT scan as compared to patients with private insurance. Additional findings are that black patients are 42% less likely to receive a CT scan than white patients.

CONCLUSIONS AND IMPLICATIONS: Patients on Medicaid are significantly less likely to receive a CT when presenting to the ED with AAP. Differences in diagnostic care may correlate to inferior health outcomes in patients without private insurance.