Emergency Department Visits for Ambulatory Care Sensitive Conditions by Persons with Rheumatoid Arthritis: A Population-Based Study

Objectives Ambulatory Care Sensitive Conditions (ACSCs) are conditions where appropriate access to ambulatory care could prevent or reduce complications, a more severe disease course, or the need for hospitalizations. We conducted this study to estimate the emergency department (ED) visit rates for ACSCs by persons with rheumatoid arthritis relative to age- and sex-matched general population controls. Methods We conducted a retrospective cohort study in Alberta, identifying individuals meeting a validated case definition for RA based on ICD-9-CM and ICD-10-CA/CM codes from 2002-2023. General population controls were identified by matching age, sex, and date of diagnosis. ED visits for any ACSC, as defined by the Canadian Institute for Health Information (grand mal seizures, chronic lower respiratory diseases, asthma, diabetes, heart failure and pulmonary edema, hypertension, and angina) were identified by ICD codes listed as the most responsible diagnosis in the National Ambulatory Care Reporting System (NACRS). The frequency of any ACSC ED visit and incidence rates and ratios between cases and controls were calculated 5 years from date of diagnosis using a multivariable regression model. Results From the incident cohort of 52,596 cases and 210,384 controls, there were 39,288 cases and 117,828 controls with an ED visit (67% female, 56% urban, mean age 64 years; comparable between cases and controls). Approximately 75% of the incident cohort has had at least 1 ED visit from 2007-2023. There was a 76% increase in the frequency of ED visits for ACSCs among cases over the study period, from 3.3% of all ED visits by cases in 2007 to 5.8% in 2023. After adjusting for age, sex, and location, the incidence rate for ACSC ED visits among those with RA was 24.06 per 100 person-years (95% CI 21.34-27.12) and 21.45 per 100 person-years (95% CI 19.68-23.39) for controls (Table 1). The adjusted incidence rate ratio showed that RA cases had a 12% higher risk of ACSC ED visits compared to controls (IRR 1.12, 95% CI 1.08, 1.16). Table 1. Crude and adjusted incidence rates for ACSC ED visits among cases and controls. Conclusion People with RA have a 12% higher rate of avoidable ED visits in the first 5 years following diagnosis compared to those without RA. Over the years, more persons with RA have visited the ED for ACSCs, with a marked reduction during the COVID-19 pandemic restrictions. Improved ambulatory care access and quality, inclusive of primary care and subspecialty care, is proposed to reduce the burden on the acute care system and improve quality of care.

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