{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T03:11:27Z","timestamp":1787886687328,"version":"build-2784847793"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T00:00:00Z","timestamp":1746662400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Discharge against medical advice (DAMA) and inpatient admission (IA) among emergency department (ED) visits are two important outcomes in hospital utilization, while the first one has been mainly considered a negative outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>This study aimed to examine the association of socioeconomic factors with DAMA and IA among ED visits with substance use (age 12\u201364\u202fyears) before and after the COVID-19 pandemic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study retrospectively analyzed the Nationwide Emergency Department Sample (NEDS) from 2019 to 2020. The International Classification of Diseases 10th Revision (ICD-10) codes were used to identify opioid, cannabis, and alcohol use, and smoking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The pandemic was significantly associated with higher odds of IA (OR 1.04, CI 1.02\u20131.06). Female gender and rural hospitals were adversely associated with both DAMA and IA, but lower household incomes were positively and negatively associated with DAMA and IA, respectively. Race and health insurance were partly differently associated with these outcomes. Asian patients exhibited significantly lower odds (OR 0.82, CI 0.71\u20130.88) regarding DAMA. Black (OR 0.79, CI 0.78\u20130.80) and Native American patients (OR 0.87, CI 0.82\u20130.90) exhibited lower odds, and Hispanic (OR 1.05, CI 1.03\u20131.06) and Asian patients (OR 1.40, CI 1.33\u20131.44) had higher odds compared to White patients in terms of AI. Except for self-pay, which was associated with lower odds of IA, Medicaid, self-pay, and free care were significantly associated with higher odds of DAMA and IA. Our results also showed that the COVID-19 pandemic affected the association of health insurance with IA, but not with DAMA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These findings highlight the complex association of socioeconomic factors with DAMA and IA. By addressing these differences within the hospital setting, providers can mitigate the negative consequences of substance use on patient health and reduce the burden on healthcare systems.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1431384","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T05:26:34Z","timestamp":1746681994000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Socioeconomic differences in discharge against medical advice and hospital admission among emergency department visits associated with substance use in the United States"],"prefix":"10.3389","volume":"13","author":[{"given":"Zahra","family":"Mojtahedi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pearl","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji","family":"Yoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binglong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay J.","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.ajem.2022.04.008","article-title":"COVID-19 outbreak impact on discharge against medical advice from the ED: a retrospective study","volume":"57","author":"Aydin","year":"2022","journal-title":"Am J Emerg Med"},{"key":"ref2","year":""},{"key":"ref3","year":""},{"key":"ref4","doi-asserted-by":"publisher","first-page":"4389","DOI":"10.3390\/ijerph20054389","article-title":"Mental health conditions- and substance use-associated emergency department visits during the COVID-19 pandemic in Nevada, USA","volume":"20","author":"Mojtahedi","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"ref5","year":""},{"key":"ref6","doi-asserted-by":"publisher","first-page":"111","DOI":"10.3390\/healthcare9020111","article-title":"Why do patients leave against medical advice? Reasons, consequences, prevention, and interventions","volume":"9","author":"Albayati","year":"2021","journal-title":"Healthcare"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e2345437","DOI":"10.1001\/jamanetworkopen.2023.45437","article-title":"Race and ethnicity and emergency department discharge against medical advice","volume":"6","author":"Tsai","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"291","DOI":"10.36518\/2689-0216.1530","article-title":"Who left the hospital against medical advice during the early COVID-19 pandemic?","volume":"4","author":"Werner","year":"2023","journal-title":"HCA Healthc J Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1001\/jamainternmed.2018.4725","article-title":"Trends in emergency department visits and admission rates among US acute care hospitals","volume":"178","author":"Lin","year":"2018","journal-title":"JAMA Intern Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.ajem.2020.11.029","article-title":"Decreased hospital admissions through emergency departments during the COVID-19 pandemic","volume":"42","author":"Nourazari","year":"2021","journal-title":"Am J Emerg Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.ajem.2020.12.009","article-title":"Trends in outpatient emergency department visits during the COVID-19 pandemic at a large, urban, academic hospital system","volume":"40","author":"Giannouchos","year":"2021","journal-title":"Am J Emerg Med"},{"key":"ref12","year":""},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2204","DOI":"10.2105\/AJPH.2006.100164","article-title":"Factors associated with patients who leave acute-care hospitals against medical advice","volume":"97","author":"Ibrahim","year":"2007","journal-title":"Am J Public Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1076","DOI":"10.5811\/westjem.2021.3.50839","article-title":"Emergency department visits by patients with substance use disorder in the United States","volume":"22","author":"Zhang","year":"2021","journal-title":"West J Emerg Med"},{"key":"ref15","article-title":"Emergency department visits in rural and non-rural community hospitals, 2008","volume-title":"Healthcare cost and utilization project (HCUP) statistical briefs","author":"Hines","year":"2006"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1177\/1077558712470565","article-title":"Variation in emergency department admission rates across the United States","volume":"70","author":"Pines","year":"2013","journal-title":"Med Care Res Rev"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"8416","DOI":"10.1073\/pnas.1406402111","article-title":"Explaining Asian Americans' academic advantage over whites","volume":"111","author":"Hsin","year":"2014","journal-title":"Proc Natl Acad Sci USA"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"300","DOI":"10.3389\/fmed.2020.00300","article-title":"Trends of racial\/ethnic differences in emergency department care outcomes among adults in the United States from 2005 to 2016","volume":"7","author":"Zhang","year":"2020","journal-title":"Front Med"},{"key":"ref19","first-page":"e157","article-title":"Nevada's Medicaid expansion and admissions for ambulatory care-sensitive conditions","volume":"24","author":"Mazurenko","year":"2018","journal-title":"Am J Manag Care"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-024-09278-5","article-title":"Patients discharged \u201cagainst medical advice\u201d more than once: a cross-sectional descriptive analysis of a vulnerable population","author":"Holmes","year":"2024","journal-title":"J Gen Intern Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.genhosppsych.2022.07.003","article-title":"Insurance and inpatient admission of emergency department patients with depression in the United States","volume":"78","author":"Gao","year":"2022","journal-title":"Gen Hosp Psychiatry"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"552","DOI":"10.5811\/westjem.2021.1.49279","article-title":"Emergency department access during COVID-19: disparities in utilization by race\/ethnicity, insurance, and income","volume":"22","author":"Lowe","year":"2021","journal-title":"West J Emerg Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"3193","DOI":"10.3390\/healthcare11243193","article-title":"Telehealth utilization and good care among informal caregivers: health information National Trends Survey, 2022","volume":"11","author":"Mojtahedi","year":"2023","journal-title":"Healthcare"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1121779","DOI":"10.3389\/fpubh.2023.1121779","article-title":"Urban-suburb disparities in pre-hospital emergency medical resources and response time among patients with out-of-hospital cardiac arrest: a mixed-method cross-sectional study","volume":"11","author":"Jin","year":"2023","journal-title":"Front Public Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"101812","DOI":"10.1016\/j.cpr.2019.101812","article-title":"Perceptions of mental health and perceived barriers to mental health help-seeking amongst refugees: a systematic review","volume":"75","author":"Byrow","year":"2020","journal-title":"Clin Psychol Rev"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1431384\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T05:26:36Z","timestamp":1746681996000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1431384\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,8]]},"references-count":25,"alternative-id":["10.3389\/fpubh.2025.1431384"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1431384","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,8]]},"article-number":"1431384"}}