Cost-Related Delay in Care Tied to Higher ED Use

TOPLINE:

Latino adults who reported delaying or forgoing care for cost-related reasons had 78% higher odds of emergency department (ED) visits than those who did not delay care, with even higher odds among those reporting poor health, a study found.

METHODOLOGY:

Researchers conducted a cross-sectional study using pooled data from the National Health Interview Survey and included 17,344 Latino adults aged 18-64 years (median age, 36.7 years; 50.7% women; 48.9% with private insurance) surveyed between 2019 and 2024.
Participants were categorized as having or not having self-reported cost-related delayed or forgone care (physical or mental) in the past 12 months (16.9% vs 83.1%, and comparisons were made for ED visits (at least one ED visit vs no ED visits).
The primary outcome was self-reported ED visits in the past 12 months (yes or no).
Secondary analyses examined subgroup differences by nativity, education, insurance, and other covariates, along with interaction effects.

TAKEAWAY:

Participants who reported cost-related delayed or forgone care had significantly higher odds of reporting at least one ED visit in the past 12 months than those who did not report delaying or forgoing care (adjusted odds ratio [aOR], 1.78; P < .001).
Women (aOR, 1.33; 95% CI, 1.21-1.47), individuals with less than a high school education (aOR, 1.60; 95% CI, 1.34-1.92), individuals with public insurance (aOR, 1.69; 95% CI, 1.49-1.91), and individuals who reported poor health status (aOR, 4.09; 95% CI, 3.05-5.48) had higher odds of at least one ED visit than men, college graduates, individuals with private insurance, and individuals who self-reported excellent health, respectively.
Individuals born outside the US had lower odds of having at least one ED visit (aOR, 0.75; 95% CI, 0.65-0.86) than those born in the US. In contrast, nonMexican Latino heritage was associated with higher odds of having at least one ED visit than Mexican heritage (aOR, 1.18; 95% CI, 1.07-1.30).
A significant three-way interaction among delayed or forgone care, nativity, and education was observed (aOR, 1.15; P = .02). Individuals not born in the US had lower ED visit probabilities than US-born Latino individuals. Higher educational attainment was associated with lower ED visit probabilities among both individuals born in the US and those born outside the US.

IN PRACTICE:

“Reporting cost-related delayed or forgone care was associated with 78% increased odds of ED visits, compared with no reported delayed or forgone care, underscoring the need for policies that reduce financial barriers to timely health care. Latino individuals born outside the US also had lower odds of ED use compared with their US-born counterparts, underscoring the importance of considering within-group differences in use of emergency services,” the authors wrote.

SOURCE:

The study was led by Esmeralda Melgoza, PhD, MPH, CHES, Stanford University School of Medicine, Palo Alto, California. It was published online on March 12, 2026, in JAMA Network Open.

LIMITATIONS:

The study was limited by its cross-sectional design, precluding causal inference. The survey excluded institutionalized and homeless populations, limiting the generalizability of the findings. Self-reported data introduced potential recall bias. Changes in data collection during the COVID-19 pandemic may have affected responses; however, sensitivity analyses suggested consistent findings.

DISCLOSURES:

No funding sources or conflicts of interest were reported for the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.