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Emergency Department Volume and Racial and Ethnic Differences in Waiting Times in the United States

Sonnenfeld, Nancy PhD*; Pitts, Stephen R. MD; Schappert, Susan M. MA*; Decker, Sandra L. PhD*

doi: 10.1097/MLR.0b013e318245a53c
Brief Reports

Background: Racial and ethnic differences in emergency department (ED) waiting times have been observed previously.

Objectives: We explored how adjusting for ED attributes, particularly visit volume, affected racial/ethnic differences in waiting time.

Research Design: We constructed linear models using generalized estimating equations with 2007–2008 National Hospital Ambulatory Medical Care Survey data.

Subjects: We analyzed data from 54,819 visits to 431 US EDs.

Measures: Our dependent variable was waiting time, measured from arrival to time seen by physician, and was log transformed because it was skewed. Primary independent variables were individual race/ethnicity (Hispanic and non-Hispanic white, black, other) and ED race/ethnicity composition (covariates for percentages of Hispanics, blacks, and others). Covariates included patient age, triage assessment, arrival by ambulance, payment source, volume, region, and teaching hospital.

Results: Geometric mean waiting times were 27.3, 37.7, and 32.7 minutes for visits by white, black, and Hispanic patients. Patients waited significantly longer at EDs serving higher percentages of black patients; per 25 point increase in percent black patients served, waiting times increased by 23% (unadjusted) and 13% (adjusted). Within EDs, black patients waited 9% (unadjusted) and 4% (adjusted) longer than whites. The ED attribute most strongly associated with waiting times was visit volume. Waiting times were about half as long at low-volume compared with high-volume EDs (P<0.001). For Hispanic patients, differences were smaller and less robust to model choice.

Conclusions: Non-Hispanic black patients wait longer for ED care than whites primarily because of where they receive that care. ED volume may explain some across-ED differences.

*Division of Health Care Statistics, National Center for Health Statistics, Hyattsville, MD

Department of Emergency Medicine, Emory University, Atlanta, GA

Disclaimer: The views expressed in this article are the sole opinions of the authors and not the agencies they represent.

The authors declare no conflict of interest.

Reprints: Nancy Sonnenfeld, PhD, Centers for Medicare and Medicaid Services, Baltimore, MD 21244. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.