The Effect of Community Socioeconomic Disadvantage on Emergency Department Utilization among Medicare Beneficiaries with Serious Mental Illness

Abstract: This cross-sectional study examined the relationship between community socioeconomic disadvantage and emergency department (ED) visit rates among Medicare beneficiaries with serious mental illness (SMI). We analyzed 2018 Medicare claims data among beneficiaries with SMI in six U.S. states, merged with 2020 Area Deprivation Index data. Our sample included 30,425 community-dwelling Medicare beneficiaries with diagnoses of SMI, such as schizophrenia, bipolar disorder, and major depressive disorder, who receive care in primary care practices. We found higher rates of all-cause and preventable ED visits among beneficiaries in the most disadvantaged communities compared with those in the least disadvantaged communities. Individuals in these communities had a 16% and 27% higher rate of all-cause and preventable ED visits, respectively. Findings highlight the need for health care administrators and policymakers to invest in developing community resources and sustaining an adequate health care workforce in socioeconomically disadvantaged communities.