Racial and Ethnic Disparities in Multimorbidity in Emergency Department Visits: A Latent Class Analysis by Intellectual and Developmental Disability Status in the United States

INTRODUCTION: Multiple chronic conditions (MCC) impose a substantial burden on emergency department (ED) systems in the United States, yet little is known about how patterns of chronic disease co-occurrence differ at the intersection of intellectual and developmental disability (IDD) status and race/ethnicity. This study aimed to identify distinct latent classes of chronic condition patterns among ED patients and to examine the likelihood of class membership across IDD and racial/ethnic subgroups. METHODS: Using the 2020 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample (HCUP-NEDS), we conducted a latent class analysis (LCA) of 20 chronic conditions among adults aged 18-64 with and without IDD. A multinomial logistic regression estimated the likelihood of class membership by IDD and race/ethnicity cohorts, using White non-IDD adults as the reference group. RESULTS: Five latent classes emerged: Minimal Disease (38.9%), Cardiometabolic (26.8%), Mental Health-Chronic Pain (16.2%), Cardiovascular-Renal (12.1%), and Complex Condition (CHC) (6.0%). All IDD groups, regardless of race/ethnicity, had significantly higher odds of presenting with Complex Condition compared to White non-IDD adults. Compared to White non-IDD adults, the risk of Complex Condition was highest among Black adults with IDD (AOR = 3.39, 95% CI: 2.57-4.48), followed by Other/Mixed, Latinx, and White adults with IDD. CONCLUSIONS: Adults with IDD, particularly those from racial and ethnic minority backgrounds, demonstrate markedly elevated odds of presenting to the ED with complex, multisystem chronic disease profiles compared to White non-IDD adults. These findings underscore the need for integrated, intersectionally informed chronic disease management in ED settings and highlight critical gaps in primary and preventive care access for adults with IDD from marginalized racial/ethnic groups.