Learning the hard way: the role of education in emergency department utilization amidst a pandemic

Purpose This study analyses how educational attainment shapes emergency department (ED) utilization during the COVID-19 pandemic, focusing on the Campania region in Italy. Are different levels of education associated with heterogeneous behavioral responses to the health emergency? Design/methodology/approach Using data from all EDs operating in Campania and demographic information at the municipal level, the study estimates a series of fractional response models to assess how education is associated with changes in ED visits during 2020 compared with the 2016–2019 baseline. Findings Results show a U-shaped relationship between education and ED use: municipalities with either lower or higher educational attainment experienced proportionally greater increases in ED visits during the pandemic. This pattern is robust to several model specifications and is not explained by local contagion dynamics. Practical implications Findings suggest that both informational disadvantages among less-educated groups and behavioral responses among highly educated groups may contribute to inefficient ED use in pandemic conditions. Policies that enhance health literacy calibration and target communication to specific educational groups may improve resource allocation. Originality/value This article provides an analysis of the education–behavior nexus in pandemic ED utilization at a fine-grained territorial level. By combining administrative ED records with demographic data, it offers new evidence on the behavioral consequences of educational heterogeneity during public-health crises.