Rural disparities in emergency department utilization for migraine care

• Published in: Headache 2024-01, Vol.64 (1), p.37-47
• Main Authors: Rhudy, Christian, Schadler, Aric, Huffmyer, Mark, Porter, Lindsey
• Format: Article
• Language: English
• Subjects: Age; Analgesia; Analgesics, Opioid; Appalachia; Confidence intervals; Cross-Sectional Studies; emergency department; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Epidemiology; Evaluation; Headache; Health Care Costs; Humans; Migraine; Migraine Disorders - epidemiology; Migraine Disorders - therapy; Narcotics; Opioids; Patients; Population studies; Populations; Risk factors; rural; Rural areas; Rural Population; Rural populations; Socioeconomics; United States - epidemiology; Utilization
• ISSN: 0017-8748; 1526-4610
• DOI: 10.1111/head.14659

Objective To evaluate differences in emergency department (ED) utilization and quality of care for migraine in patients with rural and nonrural residences. Background Migraine is a significant problem in the United States with direct health‐care utilization cost amounting to US $4.2 billion annually. A considerable portion of this cost is attributed to more than 4 million annual ED visits for migraine and headache. Previous research has documented health disparities among rural populations in other disease states, which can be influenced by factors such as socioeconomic status and health‐care access. Given these associations, it was hypothesized that patients with rural residence in a national sample would have increased ED utilization for migraine compared to patients with nonrural residence. Methods This was a cross‐sectional epidemiologic study to evaluate rural disparities in ED utilization and quality of care for migraine in the United States in 2019. ED encounter data were collected from the Healthcare Cost and Utilization Project (HCUP) Nationwide Emergency Department Sample (NEDS) and Kentucky State Emergency Department Database (KY‐SEDD). The primary outcome was crude and age‐adjusted rates of ED encounters for migraine per 10,000 population. ED encounters were included if they had a primary International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code of G43.xx. ED encounters lacking sufficient data to classify into a geographic group were excluded. Secondary outcomes examined differences in quality of care, including mean ED charges and the proportion of encounters with medication administration, imaging, and nerve block service codes between groups. Results One hundred eighty‐three thousand two hundred eleven national ED discharges were classified as rural patient encounters and 627,176 were classified as nonrural. The rural group had significantly higher crude and age‐adjusted rates of ED utilization for migraine (crude: rural 39.8, 95% confidence interval [CI] 36.9–42.7; nonrural 22.2, 95% CI 21–23.5 and age‐adjusted: rural 41.8, 95% CI 38.8–44.8; nonrural 23.4, 95% CI 22.1–24.7). Opioid utilization was higher in rural encounters (rural n = 26,764, 14.6%; nonrural n = 50,367, 8%; p