Examining Emergency Department Utilization and Hospital Admissions Among Older Undocumented Immigrants: Insights From a Primary Care County Program.

Abstract

Background and objectives: Limited access to preventive healthcare among undocumented immigrants may increase healthcare needs with age, leading to higher emergency department (ED) utilization and hospitalizations. Although county programs like My Health LA (MHLA) in Los Angeles County (LAC), California, provide primary care to older undocumented adults, our understanding of the group's specific health issues prompting ED visits and potential legal status (i.e., undocumented vs documented) differences in ensuing hospital admissions is limited.We compared legal status differences in the likelihood of an ED-originating hospital admission among older immigrant patients in LAC. We examined the top 10 diagnostic categories for undocumented (MHLA and non-MHLA participants) and documented patients to understand the health conditions that bring older immigrants to the ED and those that result in hospital admission.

Research design and methods: This retrospective study analyzed 239,861 ED encounters from 2016 to 2020 across 3 LAC safety-net hospitals involving immigrant patients aged 50+. Multivariable mixed-effects models estimated the relationship between patient legal status and odds of ED-originating hospital admission.

Results: Undocumented patient encounters, both MHLA (OR = 0.75, 95% CI: 0.71-0.78) and non-MHLA (OR = 0.88, 95% CI: 0.85-0.91), were less likely to result in ED-originating hospital admissions than documented patient encounters. The top clinical reasons for treat-and-release (i.e., ED visits discharged home) visits and ED-originating hospital admissions among undocumented immigrants were similar to those of their documented counterparts.

Discussions and implications: Older undocumented patients in MHLA were less likely to be admitted following an ED visit. Health programs should be designed for both documented and undocumented patients to improve healthcare outcomes among immigrant communities.