U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Reasons for Emergency Room Use Among U.S. Adults 

Aged 18–64: National Health Interview Survey,

2013 and 2014 

by Renee M. Gindi, Ph.D., M.P.H.; Lindsey I. Black, M.P.H.; and Robin A. Cohen, Ph.D.,

Division of Health Interview Statistics

Abstract

Objective—This report examines the percentage of adults aged 18–64 who had an 

emergency room (ER) visit and their reasons for the most recent visit. 

Methods—Using the 2013 and 2014 National Health Interview Survey, estimates 

of use in the past year and reasons for most recent ER visit are presented. A hierarchy 

was created to classify respondents’ reasons for their last ER visit into three mutually 

exclusive categories: seriousness of the medical problem, doctor’s office or clinic was 

not open, and lack of access to other providers. 

Results—In 2014, 18% of adults visited the ER one or more times. Seriousness 

of the medical problem was the reason for the most recent ER visit for 77% of adults 

aged 18–64, 12% because their doctor’s office was not open, and 7% because of a 

lack of access to other providers (4% did not select any reason). Percentages were 

similar in 2013. Controlling for other variables, adults with Medicaid were most likely 

to report that seriousness of the medical problem was the reason for the most recent 

ER visit. Adults with private coverage were most likely to have used the ER because 

the doctor’s office was not open. Uninsured adults were more likely than adults with 

private coverage to have visited the ER because they lacked access to other providers. 

Differences in reasons for use between demographic groups were also identified. 

Conclusions—Few changes in ER use were noted between 2013 and 2014. 

Differences persist in ER use and reasons for ER use at most recent visit by insurance 

type as well as sociodemographic characteristics.

Keywords: health • health insurance • health care access • health care utilization

Introduction

Approximately 20% of U.S. adults 

seek health care at the emergency room 

(ER) each year, a percentage that has 

remained largely unchanged in the last 

decade (1). Consistently, health insurance 

type has been associated with ER usage 

for adults, with the highest rates of use 

among adults with public health coverage 

such as Medicaid, relative to adults who 

were uninsured or had private health 

insurance (2). This higher rate of use may 

be related to more serious medical needs 

in the Medicaid population; analyses of 

national surveys indicate that adults aged 

18–64 with Medicaid are generally in 

poorer health than people with private 

coverage and the uninsured, even when 

accounting for age (3) and income (4–6). 

Even so, there is a common perception 

that ER visits by adults with Medicaid 

tend to be nonemergency visits (7,8). 

Concerns about the high costs of ER care 

relative to office-based care—particularly 

among adults with Medicaid—have led 

some state legislatures to try to reduce the 

number of nonemergency ER visits by 

increasing cost sharing or other payment 

strategies (9,10). While differentiation 

between emergency and nonemergency 

visits is required before a program may 

increase cost sharing, multiple (and 

Number 90  February 18, 2016

National Health Statistics Reports
Page 2 National Health Statistics Reports  Number 90  February 18, 2016

sometimes conflicting) methods 

of differentiation exist (10–13).

Since 2011, the National Health 

Interview Survey (NHIS) has collected 

detailed information on reasons for ER 

use (14), and preliminary estimates were 

produced from these questions 

in 2012 (15). While NHIS does not 

collect clinical information on a 

specific ER visit, the questions about 

the reasons for the ER visit might be 

useful in approximating avoidable and 

unavoidable ER use (16). In addition to 

health insurance type, NHIS also collects 

detailed demographic information on all 

respondents, allowing for an analysis of 

the relative impacts of insurance type 

on ER use among relevant population 

groups.

Between 2013 and 2014, 7.9 million 

adults aged 18–64 gained health care 

coverage (17). It has been difficult to 

predict the impact of the Affordable Care 

Act (ACA) and the expansion of both 

private and Medicaid coverage on ER 

use, as current research in the area shows 

mixed results. While research from 

Massachusetts and Oregon suggests that 

increased provision of health coverage 

may increase ER use (18,19), a recent 

study from California suggests that these 

effects may be short-lived (20). At a 

national level, expansion of private 

health insurance for young adults under 

ACA was associated with a small but 

statistically significant reduction in 

overall ER usage by those aged 19–25 

(21). Even prior to ACA implementation, 

newly insured adults were shown to 

have higher rates of ER use (22). The 

changing composition of the Medicaid 

population may also influence ER use. 

The uninsured population eligible for 

Medicaid enrollment is less likely than 

current enrollees to have several chronic 

medical conditions (4), but it has higher 

rates of some health-risk behaviors (5). 

This report examines the percentage 

of adults aged 18–64 using the ER in the 

past 12 months and the reasons for their 

most recent ER visit. These analyses use 

data from the 2013 and 2014 NHIS, the 

periods immediately before and after the 

full implementation of ACA. Estimates 

are presented for adults aged 18–64 

overall, by health insurance coverage 

status, and selected demographic 

characteristics.

Methods

Data source

Data from the 2013 and 2014 NHIS 

were used to generate the estimates 

presented in this report. NHIS is a 

multipurpose health survey of the U.S. 

civilian noninstitutionalized population. It 

is conducted continuously for the Centers 

for Disease Control and Prevention’s 

National Center for Health Statistics by 

trained interviewers from the U.S. Census 

Bureau. Data are collected in person at 

the respondent’s home using computerassisted personal interviewing, but 

follow-ups to complete interviews may 

be conducted over the telephone.

NHIS consists of both a core set 

of questions that remain relatively 

unchanged from year to year as well 

as supplemental questions that are not 

asked every year. The core consists of 

four main components: the Household 

Composition Section, the Family Core, 

the Sample Adult Core, and the Sample 

Child Core. The Household Composition 

Section collects basic demographic 

and relationship information about 

all members of all families living in a 

household. The Family Core Section 

collects demographic, health insurance 

information, and basic health information 

about all family members from a 

single family member (the “family 

respondent”). For the Sample Adult 

Core, one adult per family (the “sample 

adult”) is randomly selected to respond to 

detailed health questions. For the Sample 

Child Core, one child per family (the 

“sample child”) is randomly selected, 

and a knowledgeable adult (usually the 

parent) responds on the child’s behalf. 

Further information on the survey can be 

found at: http://www.cdc.gov/nchs/nhis.

htm.

Analyses in this report were based 

on data collected on 26,825 sample adults 

aged 18–64 in 2013 and 28,053 sample 

adults aged 18–64 in 2014. The overall 

response rate for sample adults (of all 

ages) was 61.2% in 2013 and 58.9% in 

2014.

Emergency room questions

Questions regarding an adult’s ER 

use are included in the Sample Adult 

Core, as part of the Adult Health Care 

Access and Utilization section of the 

2013 and 2014 NHIS. Respondents are 

asked, “During the past 12 months, how 

many times have you gone to a hospital 

ER about your own health?” Among 

those with at least one ER visit in the past 

12 months, a series of detailed questions 

was asked about the respondent’s most 

recent ER visit. Respondents were asked 

if their most recent ER visit was on a 

night or weekend and if their most recent 

visit resulted in a hospital admission. 

Next, respondents were asked whether 

their most recent visit to the ER was due 

to any of a list of eight reasons (Table 

A). Respondents could select more than 

one reason or none of the reasons listed. 

For this report, a hierarchy was created 

to classify respondents’ reasons for their 

last ER visit into three mutually exclusive 

categories (Table A).

The “seriousness of the medical 

problem” category attempts to capture 

medical emergency visits and includes 

respondents who reported at least one of 

the following reasons: “health provider 

advised to go,” “problem was too serious 

for the doctor’s office or clinic,” “only 

a hospital could help,” or “arrived by 

ambulance or other emergency vehicle.” 

Among those who had not selected 

a reason reflecting the seriousness of the 

medical problem, those who selected 

“doctor’s office or clinic was not open” 

as a reason for the visit were placed 

in the “doctor’s office or clinic was 

not open” category. While these visits 

were not described by respondents as 

being associated with serious medical 

conditions, these respondents were 

indicating a medical need at a time 

when their usual health professional was 

unavailable. 

Among those whose most recent 

visit was not due to the seriousness 

of the medical problem and was not 

because the doctor’s office was not open, 

respondents were placed in the “lack of 

access to other providers” category if 

they reported at least one of the following 

reasons: “didn’t have another place to 

go,” “emergency room is the closest 

provider,” or “get most of their care at the 
National Health Statistics Reports  Number 90  February 18, 2016 Page 3

emergency room.” Respondents in this 

category provided reasons for the most 

recent ER visit that reflected only a lack 

of access to providers other than the ER, 

rather than a medical emergency or an 

inability to see a regular provider. 

Approximately 4% of respondents 

did not select any of the reasons and 

were not classified into one of the three 

mutually exclusive categories.

Health insurance 

Questions regarding an individual’s 

health insurance coverage are included 

in the Family Core component. The 

family respondent was asked about the 

health insurance coverage for each family 

member at the time of the interview. 

For this report, a hierarchy was created 

to classify health insurance into three 

mutually exclusive categories: private, 

Medicaid, and uninsured. 

Private health insurance includes 

any comprehensive private insurance 

plan (including health maintenance and 

preferred provider organizations). These 

plans include those obtained through an 

employer, purchased directly, purchased 

through local or community programs, or 

purchased through the Health Insurance 

Marketplace or a state-based exchange. 

Private coverage excludes plans that 

pay for only one type of service, such as 

accidents or dental care. The Medicaid 

insurance coverage category includes 

those without private insurance who 

reported Medicaid, Children’s Health 

Insurance Program (CHIP), and other 

state-sponsored health plans. Adults 

were defined as uninsured if they did not 

have any private insurance, Medicare, 

Medicaid, CHIP, state-sponsored or other 

government-sponsored health plan, or 

military plan at the time of interview. 

Adults also were defined as uninsured 

if they had only Indian Health Service 

coverage or only had a private insurance 

plan that paid for one type of service, 

such as accidents or dental care. 

Estimates are shown for these 

specific health insurance coverage 

types. Adults with other types of health 

insurance (other government-sponsored 

or military health plans) were classified 

as having “Other” insurance, and are 

included in the totals but not shown 

separately.

Demographic variables

Demographic characteristics of adults 

presented in this report include: age, 

sex, race and ethnicity, and metropolitan 

status of residence. All demographic 

characteristics with the exception of area 

of residence are based on the family 

respondent’s report. 

Age was categorized into three

groups (18–29, 30–44, and 45–64) to

reflect the different health care needs in

these age groups. Previous research has

shown that young adults receive a greater

proportion of their care at an ER compared 

with other age groups (23). The 18–29 age 

group is one noted for transitions between

youth and adulthood, and a time when

patterns of health care access and health 

behaviors are developing (24). At the other 

end of the spectrum, adults aged 45–64

were grouped together because they have

a higher prevalence of chronic conditions 

(25).

Estimates are shown for some 

specific race and ethnicity groups: 

non-Hispanic white (single race), 

non-Hispanic black (single race), and 

Hispanic. Non-Hispanic persons of 

other or multiple races are not shown 

separately due to insufficient sample sizes 

but are included in the totals. 

Area of residence was classified 

in two categories: metropolitan or 

nonmetropolitan, based on the household 

residence location. Metropolitan is 

defined as being located within a 

metropolitan statistical area, defined 

as a county or group of contiguous 

counties that contains at least one 

urbanized area of 50,000 population or 

more. Surrounding counties with strong 

economic ties to the urbanized area are 

also included as a metropolitan area of 

residence. Nonmetropolitan is defined 

as an area that does not include a large 

urbanized area and is generally thought 

of as more rural.

Statistical analyses

This report first presents patterns 

of ER use among the civilian, 

noninstitutionalized population of adults 

aged 18–64. Estimates of any use and 

frequency of use (none, one, and two or 

more times) in the past year by insurance 

status and demographic characteristics 

are presented. Next, the distribution 

of reasons for the most recent ER visit 

among adults who have used the ER 

within the past 12 months was examined 

by insurance status and demographic 

characteristics. 

Although this report is primarily 

intended to provide basic descriptive 

statistics for key population subgroups 

that may guide future analyses, it also 

presents results from a series of multiple 

logistic regressions with selected 

Table A. Reason for most recent emergency room visit and categorization in a hierarchical variable

Reason for visit Category Classification

Health provider advised to go

1 Seriousness of the medical problem Problem was too serious for the doctor’s office or clinic

Only a hospital could help

Arrived by ambulance or other emergency vehicle

Doctor’s office or clinic was not open 2 Doctor’s office or clinic was not open

Didn’t have another place to go

Emergency room is the closest provider 3 Lack of access to other providers

Get most of care at the emergency room

SOURCE: National Health Interview Survey, 2013 and 2014.
Page 4 National Health Statistics Reports  Number 90  February 18, 2016

interactions. Regression models include 

factors associated with any use of the 

ER and with each of the three categories 

of reasons for ER use. Adjusted odds 

ratios (AORs) are shown, controlling 

for insurance type, age, sex, race and 

ethnicity, metropolitan residence, and 

survey year. Confidence intervals (CIs) 

are presented for each AOR, along with 

an indicator of statistical significance of 

the AOR. All main effects, regardless of 

significance, were retained in the final 

models. The reference groups selected 

for these models were adults with private 

insurance, adults aged 45–64, men, 

non-Hispanic white adults, and adults 

living in metropolitan areas. Interactions 

were included in the models to allow for 

differential associations of insurance type 

in the different demographic subgroups. 

Only significant interactions at the 0.05 

level were retained in the final models. 

Estimates in this report were 

calculated using sample adult weights 

and are therefore representative of 

the U.S. civilian noninstitutionalized 

population of adults aged 18–64. Data 

weighting procedures are described 

in more detail elsewhere (26). Point 

estimates, and estimates of their 

variances, were calculated using 

SUDAAN software version 11.0.0, a 

software package designed to account for 

the complex sampling design of NHIS. 

Calculations of estimates excluded 

persons with missing information for ER 

visits or reasons for most recent ER visit. 

Reliability of estimates was evaluated 

using the relative standard error (RSE), 

which is the standard error divided by the 

point estimate. Estimates were considered 

reliable if the RSE was less than 30%. 

Statistical tests performed to assess the 

significance of differences between 

annual estimates were two-tailed tests 

with no adjustments made for multiple 

comparisons. The critical value used 

for two-sided tests at the 0.05 level of 

significance was 1.96.

Results

Prevalence of ER use among 

adults aged 18–64

The percentage of adults aged 18–64 

who had visited the ER one or more 

times in the past 12 months remained 

unchanged at approximately 18% in 

both 2013 and 2014 (Figure 1). In 2014, 

14.3% of adults with private coverage 

visited the ER one or more times in the 

past 12 months, while 35.2% of adults 

with Medicaid and 16.6% of uninsured 

adults had visited the ER.

Among adults with private health 

insurance, the frequency of ER visits 

(one ER visit compared with two visits 

or more in the past 12 months) did not 

change between 2013 and 2014. The 

percentage of uninsured adults who used 

the ER two or more times decreased 

between 2013 and 2014, from 8.0% to 

5.9%. (Note that between 2013 and 2014, 

the decrease in one ER visit in the past 

12 months among adults with Medicaid, 

from 19.0% to 16.7%, was significant at 

p < 0.1 rather than p < 0.05.)

In both years, the prevalence of at 

least one ER visit in the last 12 months 

was significantly higher among adults 

with Medicaid (35.2% in 2014) than 

among uninsured adults (16.6% in 2014) 

or those with private health insurance 

(14.3% in 2014). Differences between 

uninsured adults and adults with private 

coverage were also significant. Similar 

relationships were observed when 

looking specifically at frequency of ER 

visits. In 2013 and 2014, adults with 

Medicaid had the highest prevalence 

of a single ER visit in the past 12 

months (16.7% in 2014), compared 

with uninsured adults (10.7% in 2014) 

and adults with private health insurance 

(10.2% in 2014). In both years, adults 

with Medicaid had the highest prevalence 

of two or more ER visits in the past 

12 months (18.5% in 2014), compared 

with uninsured adults (16.6% in 2014) 

Figure 1. Adults aged 18–64 with at least one visit to the emergency room in the past year, by 

number of visits, health insurance coverage status, and year: United States, 2013 and 2014

 
National Health Statistics Reports  Number 90  February 18, 2016 Page 5

and adults with private health insurance 

(14.3% in 2014), with significant 

differences between uninsured adults and 

those with private health insurance. 

Additional detail on overall ER 

use and frequency of ER visits within 

demographic subgroups by year is shown 

in Table 1. Within these demographic 

subgroups, no significant changes were 

observed in the percentage of adults 

using the ER between 2013 and 2014. 

Differences in ER use by 

demographic characteristics were 

generally consistent in 2013 and 2014. 

In both years, younger adults aged 18–29 

were more likely than adults aged 45–64 

to have visited the ER one or more times 

in the past 12 months (20.2% compared 

with 17.5% in 2014). In 2014 only, adults 

aged 30–44 were less likely than adults 

aged 45–64 to have visited the ER in the 

past 12 months. In both 2013 and 2014, 

women were more likely to visit the ER 

than men. More than one-quarter of nonHispanic black adults visited the ER in 

the past 12 months, compared with 17.5% 

of non-Hispanic white adults. Hispanic 

adults were less likely than non-Hispanic 

white adults to have visited the ER. 

Adults living in nonmetropolitan areas 

were more likely than adults living in 

metropolitan areas to have visited the ER 

in the past 12 months (21.6% compared 

with 17.4% in 2014).

Seriousness of the medical 

problem as the reason for 

the most recent ER visit

Seriousness of the medical problem 

was the reason for the most recent ER 

visit for approximately 77% of adults 

aged 18–64 who had visited the ER at 

least once in the past 12 months (Figure 

2). There were no changes between 2013 

and 2014 overall and within insurance 

coverage status. Uninsured adults 

(72.4%) were less likely than adults with 

private coverage (78.4%) and Medicaid 

(77.4%) to have seriousness of the 

medical problem as the reason for the 

most recent visit. (Note that in 2014, the 

difference between uninsured adults and 

adults with Medicaid was significant at 

p < 0.1 rather than p < 0.05.)

Table 2 provides more detail on the 

percentage of adults aged 18–64 with 

seriousness of the medical problem as 

the reason for the most recent ER visit, 

within demographic groups and by year. 

There was no significant change between 

2013 and 2014 in any demographic 

subgroup. In both years, the seriousness 

of the medical problem as the reason 

for the most recent ER visit was 

significantly more common in some age 

groups (79.8% among those aged 45–64 

compared with 73.7% among those 

aged 18–29), race groups (77.6% among 

non-Hispanic white adults compared 

with 73.0% among non-Hispanic black 

adults), and residential areas (78.5% of 

metropolitan residents compared with 

70.4% of nonmetropolitan residents).

Doctor’s office not open 

as the reason for the most 

recent ER visit

Figure 3 and Table 3 further explore 

reasons that adults used the ER at the most 

recent visit, focusing on those whose most 

recent visit to the ER was not because of 

the seriousness of the medical problem, 

but because the doctor’s office or clinic 

was not open. Among adults aged 18–64 

who used the ER in the past year, 11.8% 

indicated that the doctor’s office or clinic 

was not open as the reason for their most 

recent ER visit (Figure 3). There were 

no significant changes between 2013 and 

2014 overall and within health insurance 

coverage status. In 2013, the percentage 

of adults whose most recent visit to the 

ER was because the doctor’s office wasn’t 

open was lowest among the uninsured 

(9.0%), and did not differ significantly 

between adults with private coverage 

and adults with Medicaid (approximately 

13%). In 2014, differences between 

uninsured adults and those with private 

coverage or Medicaid were no longer 

significant.

Table 3 provides more details on 

the percentage of adults aged 18–64 

whose most recent ER visit was because 

the doctor’s office was not open, by 

demographic characteristics and year. 

No changes were noted between 2013 

and 2014 for any subgroups. In both 

Figure 2. Adults aged 18–64 with a visit to the emergency room whose last visit was due 

to the seriousness of the medical problem, by year and health insurance coverage status: 

United States, 2013 and 2014

 
Page 6 National Health Statistics Reports  Number 90  February 18, 2016

years, adults living in nonmetropolitan 

areas were more likely than adults living 

in metropolitan areas to have indicated 

that their doctor’s office was not open as 

the reason for the most recent ER visit 

(17.4% compared with 10.7% in 2014). 

Other subgroups with differences in the 

percentage indicating that the doctor’s 

office was not open as the reason for the 

most recent ER visit included: adults 

aged 30–44 more so than adults aged 

45–64 (2013), women more so than men 

(2014), and Hispanic adults less so than 

non-Hispanic white adults (2014).

Lack of access to other 

providers as the reason for 

the most recent ER visit

Figure 4 shows the percentage of 

adults whose last visit to the ER was 

due to lack of access to other providers, 

rather than the seriousness of the 

medical problem or that the doctor’s 

office was not open. In 2014, for 7.0% 

of adults aged 18–64 who used the ER 

in the past year, lack of access to other 

providers was the reason for the most 

recent ER visit (7.8% in 2013) (Figure 

4). There were no significant changes 

between 2013 and 2014 overall or by 

health insurance coverage status. In both 

years, a higher percentage of uninsured 

adults’ last visit to the ER was due to 

lack of access to other providers (15.4%) 

compared with adults with private 

coverage (4.8%) or Medicaid (7.5%). In 

2014 only, adults with Medicaid were 

more likely than adults with private 

coverage to have lack of access to other 

providers as the reason for the most 

recent ER visit.

Table 4 provides more detail on 

the percentage of adults aged 18–64 for 

whom lack of access to other providers 

was the reason for the most recent ER 

visit, by demographic characteristics and 

year. In both years, the lack of access 

to other providers as the reason for the 

most recent ER visit was significantly 

more common in some age groups 

(7.4% among ages 30–44 compared 

with 4.8% among ages 45–64) and race 

groups (10.3% among non-Hispanic 

black adults compared with 6.0% among 

non-Hispanic white adults). In 2013 

only, ER use at the most recent visit due 

to the lack of access to other providers 

was significantly less likely among 

women (compared with men) and more 

likely among younger adults aged 18–29 

(compared with adults aged 45–64).

Associations between having 

one or more ER visits in 

the past 12 months, health 

insurance coverage status, 

year, and demographic 

factors among adults aged 

18–64 

After adjusting for demographic 

factors in the multivariable models, adults 

with Medicaid had almost four times 

the odds of one or more ER visits in the 

past 12 months compared with privately 

insured adults, but no difference when 

compared with uninsured and privately 

insured adults (Table 5). Interaction terms 

between insurance coverage status and 

age group, sex, and race and ethnicity 

were significant, indicating differential 

associations of these demographic 

characteristics with ER use by insurance 

type. Differences between 2013 and 2014 

were not significant.

Uninsured younger adults aged 

18–29 and those with private insurance 

had higher odds of an ER visit in the past 

12 months than did adults in the oldest 

age group, 45–64 (AORprivate: 1.25, 95% 

CI: 1.11–1.40; AORuninsured: 1.36, 95% 

CI: 1.15–1.60). Women had increased 

odds of an ER visit in the past 12 months, 

with the largest effect observed among 

uninsured women (AORprivate: 1.17, 95% 

CI: 1.08–1.27; AORMedicaid: 1.41, 95% CI: 

1.21–1.63; and AORuninsured: 1.52, 95% CI: 

1.32–1.74).

Race and ethnicity continued to be 

associated with ER use, but the effects 

differed by insurance type. Privately 

insured non-Hispanic black adults and 

uninsured non-Hispanic black adults 

had higher odds of an ER visit than their 

non-Hispanic white counterparts, but 

Figure 3. Adults aged 18–64 with a visit to the emergency room whose last visit was due 

to the doctor’s office not being open, by year, health insurance coverage status, and 

demographic characteristics: United States, 2013 and 2014

 
National Health Statistics Reports  Number 90  February 18, 2016 Page 7

no difference was observed between 

non-Hispanic black adults and nonHispanic white adults with Medicaid 

(AORprivate: 1.42, 95% CI: 1.25–1.60; 

AORMedicaid: 1.05, 95% CI: 0.86–1.25; and 

AORuninsured: 1.52, 95% CI: 1.27–1.81). 

Uninsured Hispanic adults and Hispanic 

adults with Medicaid had lower odds 

of an ER visit than their non-Hispanic 

white counterparts. No difference was 

observed between Hispanic adults and 

non-Hispanic white adults with private 

coverage (AORprivate: 0.93, 95% CI: 

0.82–1.04; AORMedicaid: 0.63, 95% CI: 

0.53–0.76; and AORuninsured: 0.64, 95% CI: 

0.55–0.76).

Even after accounting for insurance 

type and other demographic factors, 

adults living in nonmetropolitan areas 

still had increased odds of ER use in the 

past 12 months (AOR: 1.18, 95% CI: 

1.08–1.30).

Associations between 

reasons for most recent 

emergency room visit, health 

insurance coverage status, 

year, and demographic 

factors among adults aged 

18–64 with an ER visit in the 

past 12 months

Seriousness of the medical problem

Even after adjusting for demographic 

factors in multivariable models, insurance 

status continued to be significantly 

associated with ER use at last visit due to 

the seriousness of the medical problem 

(Table 5). Among adults who had visited 

the ER in the past 12 months, adults 

with Medicaid had significantly higher 

odds of having the seriousness of the 

medical problem as the reason for the 

most recent ER visit than adults with 

private coverage (AOR: 1.59, 95% CI: 

1.18–2.15). Uninsured adults had lower 

odds of having seriousness of the medical 

problem as the reason for the most recent 

ER visit than those with private coverage 

(AOR: 0.70, 95% CI: 0.51–0.95). 

Differences between 2013 and 2014 were 

not significant.

Interaction terms between insurance 

coverage status and age group and 

metropolitan status were significant, 

indicating differential associations of 

these demographic groups with ER use 

due to the seriousness of the medical 

problem by insurance type.

Among those with an ER visit 

in the last 12 months, younger adults 

aged 18–29 had lower odds of having 

seriousness of the medical problem as the 

reason for the most recent ER visit than 

did adults in the oldest age group, 45–64, 

and the strength of this association varied 

by insurance type (AORprivate: 0.76, 95% 

CI: 0.61–0.95; AORMedicaid: 0.37, 95% 

CI: 0.26–0.52; and AORuninsured: 0.69, 

95% CI: 0.50–0.96). Non-Hispanic black 

adults were less likely than non-Hispanic 

white adults to have the seriousness of 

the medical problem as the reason for the 

most recent ER visit (AOR: 0.77, 95% 

CI: 0.65–0.91).

There were different degrees of 

association between metropolitan status 

and ER use due to the seriousness of 

the medical problem by insurance type. 

While adults living in nonmetropolitan 

areas generally had lower odds of having 

the seriousness of the medical problem 

as the reason for the most recent ER visit 

relative to those living in metropolitan 

areas, the strength and precision of this 

association varied by insurance type 

(AORprivate: 0.57, 95% CI: 0.45–0.72; 

AORMedicaid: 0.56, 95% CI: 0.42–0.76; and 

AORuninsured: 0.85, 95% CI: 0.60–1.23). 

Doctor’s office was not open

Among adults who had visited the 

ER in the past 12 months, adults with 

Medicaid (AOR: 0.55, 95% CI: 0.39–

0.78) and uninsured adults (AOR: 0.62, 

95% CI: 0.40–0.98) had lower odds of 

having the doctor’s office not open as the 

reason for the most recent visit compared 

with adults who had private coverage, 

even after adjusting for demographic 

factors. Differences between 2013 and 

2014 were not significant.

Interaction terms between insurance 

coverage status and age group were 

 

Figure 4. Adults aged 18–64 with a visit to the emergency room whose last visit was due 

to lack of access to other providers, by year, health insurance coverage status, and 

demographic characteristics: United States, 2013 and 2014
Page 8 National Health Statistics Reports  Number 90  February 18, 2016

significant, indicating differential 

associations of age groups with ER use 

due to the doctor’s office not being open 

by insurance type. Adults aged 30–44 

had higher odds of indicating that the 

doctor’s office was not open as the reason 

for the most recent ER visit relative to 

the oldest age group (AOR: 1.45, 95% 

CI: 1.13–1.87). While younger adults 

with private coverage and older adults 

with private coverage had similar odds 

of indicating the doctor’s office not being 

open as the reason for the most recent 

ER visit, young adults with Medicaid 

had significantly higher odds than older 

adults with Medicaid (AOR: 2.84, 95% 

CI: 1.90–4.25). Among adults with an ER 

visit in the past 12 months, adults living 

in nonmetropolitan areas were almost 

twice as likely to cite the doctor’s office 

was not open as the reason for the most 

recent ER visit relative to those living in 

metropolitan areas (AOR: 1.80, 95% CI: 

1.45–2.23). 

Lack of access to other providers

Among adults who had visited the 

ER in the past 12 months, uninsured 

adults were more than twice as likely to 

have lack of access to other providers 

as the reason for the most recent ER 

visit to other providers than were adults 

with private insurance (AOR: 2.44, 

95% CI: 1.64–3.64) and adults with 

Medicaid (AOR 2.11, 95% CI: 1.17–3.82, 

uninsured compared with Medicaid as 

referent, not shown in Table 5) after 

adjusting for demographic factors. 

Differences between 2013 and 2014 were 

not significant.

Interaction terms between insurance 

coverage status and sex and race were 

significant, indicating differential 

associations between sex and race with 

ER use due to lack of access to other 

providers by insurance type. Younger 

adults (aged 18–29 and 30–44) had 

higher odds of having lack of access 

to other providers as the reason for the 

most recent ER visit relative to the oldest 

age group (45–64). Women with private 

coverage had one-half the odds of men 

with private coverage of having lack of 

access to other providers as the reason 

for the most recent ER visit (AOR: 0.54, 

95% CI: 0.39–0.75). In contrast, women 

with Medicaid and uninsured women had 

similar odds as their male counterparts.

Among adults with an ER visit in 

the past 12 months, privately insured 

and uninsured non-Hispanic black 

adults had approximately twice the 

odds of having lack of access to other 

providers as the reason for the most 

recent ER visit relative to non-Hispanic 

white adults (AORprivate: 2.03, 95% CI: 

1.33–3.11; AORuninsured: 2.08, 95% CI: 

1.35–3.21). However, no difference was 

observed between Hispanic and nonHispanic white adults who had either 

private insurance or were uninsured. 

Among adults with Medicaid, there 

were no significant differences between 

non-Hispanic black, Hispanic, and nonHispanic white adults in ER use due to 

lack of access to other providers. 

Discussion

This report contributes to the 

evaluation of health insurance expansion 

and ER use nationwide by providing 

updated estimates on ER use and reasons 

for the most recent ER visit among U.S. 

adults aged 18–64. In both 2013 and 

2014, about 18% of adults visited the 

ER, indicating that ER use overall has 

not changed significantly after the first 

full year of ACA implementation. Adults 

with Medicaid coverage continue to have 

higher rates of ER use than do privately 

insured and uninsured adults. While there 

were no changes in the percentages of 

adults with private coverage or Medicaid 

using the ER or in the frequency of their 

ER use between 2013 and 2014, there 

were changes among uninsured adults. 

The percentage of uninsured adults who 

used the ER two or more times decreased 

over time.

The existing studies on ER use have 

made it difficult to predict the impact of 

ACA implementation on ER use. Results 

from state-specific health insurance 

expansion programs have suggested that 

the rate of ER use could initially rise 

following ACA (18–20). Conversely, a 

geographically diverse study of young 

adults indicated that small downward 

shifts in ER use, and particularly, ER use 

for nonurgent visits, could be expected 

after expansion of private coverage under 

ACA (21). However, this nationwide 

analysis of adults’ ER visits instead 

demonstrated little change in ER use 

during and immediately following ACA 

implementation.

Key insurance and demographic 

subgroups had higher rates of ER use. 

Consistent with results from other 

nationally representative surveys, this 

analysis found higher rates of ER use 

among adults with Medicaid (2), as well 

as among younger adults, non-Hispanic 

black adults, and women (27). 

This report noted few changes in 

the reasons for the most recent ER visit 

between 2013 and 2014 among those 

who used the ER in the past 12 months. 

In both years, the seriousness of the 

medical problem was the reason for the 

most recent ER visit for approximately 

77% of adults aged 18–64, while 12% 

visited because their doctor’s office 

was not open, and 7% visited because 

of lack of access to other providers (an 

additional 4% did not select any of the 

reasons given). Adults with Medicaid 

were more likely to have the seriousness 

of the medical problem as the reason for 

the most recent ER visit than adults with 

private coverage or the uninsured. Adults 

with private coverage were more likely 

to indicate that the doctor’s office was 

not open as the reason for the most recent 

ER visit than were adults with Medicaid 

and uninsured adults. Uninsured adults 

were more likely than adults with private 

coverage or Medicaid to have lack of 

access to providers other than the ER as 

the reason for the most recent ER visit, 

rather than a medical emergency or an 

inability to see a regular provider. 

The finding that adults with 

Medicaid were more likely than adults 

with private coverage to have the 

seriousness of the medical problem 

as the reason for the most recent ER 

visit contrasts what has been observed in 

reviews of the literature (28) and in other 

national surveys. Data from the 2011 

National Hospital Ambulatory Care 

Survey indicated that adults 

with Medicaid were less likely than 

adults with private coverage to have 

visits to the ER classified as emergent 

or urgent (7,27). This contrast could 

reflect differences over time (2011 

compared with 2013–2014) or statistical 

methodology (adjusted compared with 

unadjusted analyses). Also contributing to 

this difference may be the disagreement 

between patients’ self-reported 

seriousness of the medical problem and 

ER providers’ perception and subsequent 
National Health Statistics Reports  Number 90  February 18, 2016 Page 9

recording of the medical urgency of 

the visit (29). 

In this report, uninsured adults 

were less likely than adults with private 

coverage to have the seriousness of the 

medical problem as the reason for the 

most recent ER visit and more likely to 

have lack of access to other providers as 

the reason for the most recent ER visit. 

Previous results in this area have been 

mixed (28), but other analyses have 

indicated that uninsured adults are more 

likely than adults with private coverage 

to use the ER as a usual source of care 

(30). 

While insurance type is strongly 

associated with reasons for the most 

recent ER visit, even after accounting 

for insurance type, some demographic 

groups had noticeably higher likelihoods 

of visiting the ER for each of these three 

reasons. The demographic subgroups 

identified in this report as most likely 

to visit the ER for certain reasons were 

largely consistent with those identified 

in other studies in the United States. For 

example, in this analysis, younger adults 

were less likely than older adults to have 

the seriousness of the medical problem 

as the reason for the most recent ER 

visit and more likely to visit due to lack 

of access to other providers. As noted 

in a 2013 review article, several studies 

have indicated that younger adults were 

more likely to have nonurgent visits than 

older adults (28). Non-Hispanic black 

adults were less likely to have the 

seriousness of the medical problem as 

the reason for the most recent ER visit 

and more likely to visit due to lack of 

access to other providers compared with 

non-Hispanic white adults, although this 

was not consistent across all insurance 

coverage groups. Similarly, the evidence 

for this association in other studies 

has been mixed (28). Adults living in 

nonmetropolitan areas were less likely 

to have the seriousness of the medical 

problem as the reason for the most 

recent ER visit, consistent with other 

studies that have found lower rates of 

hospital admission among adults in 

nonmetropolitan areas compared with 

adults in metropolitan areas (27,31). 

While men in this analysis were more 

likely than women to have lack of access 

to other providers as the reason for 

the most recent ER visit, this was not 

consistent across all insurance coverage 

groups. Similarly, the evidence for this 

association in the literature has been 

mixed (28).

This analysis identified adults with 

Medicaid, uninsured adults, and adults 

living in metropolitan areas as less likely 

to indicate that the doctor’s office was not 

open as the reason for the most recent ER 

visit. Adults with Medicaid and uninsured 

adults are less likely to have a doctor’s 

office or clinic as a usual source of care 

than adults with private coverage (30), so 

it is possible that this question captures 

a general lack of access to medical 

providers for these groups rather than the 

specific need to seek services at a time 

when offices are closed. The difference 

between adults living in nonmetropolitan 

areas and adults in metropolitan areas 

in ER use due to a doctor’s office not 

being open may reflect more difficulty 

accessing physicians in nonmetropolitan 

areas (30,32).

To estimate reasons for adult ER 

use that are generalizable at the national 

level, this report uses NHIS, which has 

a nationally representative sample of the 

civilian resident population. The large 

household sample size and a wide range 

of demographic characteristics allow 

for a detailed examination of population 

subgroups. However, this report is not 

without some limitations. There is the 

potential for misclassification of the 

health insurance coverage associated with 

an ER visit because information collected 

on ER use refers to visits in the previous 

12 months, while type of insurance is 

classified based on coverage during the 

time of the interview. In addition, reasons 

for ER visits were asked regarding the 

respondent’s most recent ER visit. It is 

possible that results are subject to recall 

bias and overestimate the prevalence 

of seriousness, as some respondents 

may recall and report an ER visit that 

was serious even if it was not the most 

recent. The hierarchical classification 

of reason for visit used in this report 

is an approximation of avoidable and 

nonavoidable reasons for ER use. Other 

researchers interested in using these 

data may choose alternate classification 

systems (33).

ER use, whether appropriate or 

inappropriate, is an expensive source 

of care. This report examined the 

prevalence of ER use and reasons for 

ER use in NHIS during and after ACA 

implementation. The findings indicate 

that so far, there have been no changes 

over time, and disparities between groups 

persist. Continued monitoring of ER 

use by insurance coverage status and 

by demographic subgroups may help 

identify influential factors that can be 

addressed to reduce inappropriate ER 

use and ER use overall. In future studies, 

additional factors influencing ER use, 

such as family income and new receipt of 

insurance coverage, may be incorporated. 

Changes to the demographic composition 

of the privately insured, adults with 

Medicaid, and uninsured adults may also 

be incorporated into this monitoring. 

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National Health Statistics Reports  Number 90  February 18, 2016 Page 11

Table 1. Adults aged 18–64 with at least one visit to the emergency room, by year, number of visits, and selected characteristics:

United States, 2013 and 2014

Selected demographic

2013 2014

Zero visits

One or more 

visits One visit

Two or more 

visits Zero visits

One or more 

visits One visit

Two or more 

visits

Percent (standard error)

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.8 (0.32) 18.2 (0.32) 11.4 (0.26) 6.8 (0.21) 82.0 (0.34) 18.0 (0.34) 11.4 (0.27) 6.6 (0.23)

Health insurance coverage status

Private . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86.0 (0.36) 14.0 (0.36) 10.2 (0.31) 3.8 (0.19) 85.6 (0.39) 14.4 (0.39) 10.2 (0.33) 4.1 (0.25)

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62.3 (1.15) 37.7 (1.15) 19.0 (0.96) 18.7 (0.94) 64.8 (1.15) 35.2 (1.15) 16.7 (0.84) 18.5 (0.85)

Uninsured . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.5 (0.68) 18.5 (0.68) 10.5 (0.50) 8.0 (0.52) 83.4 (0.72) 16.6 (0.72) 10.7 (0.62) †

5.9 (0.45)

Age group

18–29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79.6 (0.69) 20.4 (0.69) 12.8 (0.58) 7.6 (0.47) 79.8 (0.76) 20.2 (0.76) 12.4 (0.59) 7.8 (0.57)

30–44. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83.0 (0.53) 17.0 (0.53) 10.6 (0.42) 6.4 (0.35) 83.2 (0.56) 16.8 (0.56) 10.9 (0.44) 5.9 (0.36)

45–64. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82.3 (0.48) 17.7 (0.48) 11.1 (0.37) 6.5 (0.30) 82.5 (0.47) 17.5 (0.47) 11.1 (0.39) 6.4 (0.30)

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84.2 (0.43) 15.8 (0.43) 10.6 (0.37) 5.3 (0.28) 84.0 (0.45) 16.0 (0.45) 11.2 (0.39) 4.8 (0.26)

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79.6 (0.45) 20.4 (0.45) 12.2 (0.35) 8.2 (0.31) 80.1 (0.48) 19.9 (0.48) 11.6 (0.35) 8.3 (0.37)

Race and ethnicity

Non-Hispanic white . . . . . . . . . . . . . . . . . . . . . . . . . 82.2 (0.41) 17.8 (0.41) 11.5 (0.34) 6.3 (0.27) 82.5 (0.43) 17.5 (0.43) 11.4 (0.36) 6.1 (0.30)

Non-Hispanic black . . . . . . . . . . . . . . . . . . . . . . . . . 74.6 (0.94) 25.4 (0.94) 14.1 (0.75) 11.3 (0.61) 73.5 (0.93) 26.5 (0.93) 15.1 (0.77) 11.4 (0.68)

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83.9 (0.63) 16.1 (0.63) 10.3 (0.53) 5.8 (0.42) 84.3 (0.64) 15.7 (0.64) 10.0 (0.54) 5.6 (0.40)

Residence

Metropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82.5 (0.34) 17.5 (0.34) 11.2 (0.28) 6.4 (0.22) 82.6 (0.37) 17.4 (0.37) 11.2 (0.29) 6.2 (0.25)

Nonmetropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.0 (0.93) 22.0 (0.93) 12.8 (0.70) 9.2 (0.65) 78.4 (0.82) 21.6 (0.82) 12.7 (0.70) 8.9 (0.57)

†

Significantly different from 2013 (p < 0.05).

NOTES: Adults with unknown health insurance coverage status are included in the totals. Adults who are of race and ethnicity groups other than non-Hispanic white, non-Hispanic black, and Hispanic 

are included in the totals but are not shown separately. 

SOURCE: CDC/NCHS, National Health Interview Survey, 2013–2014.
Page 12 National Health Statistics Reports  Number 90  February 18, 2016

Table 2. Adults aged 18–64 with a visit to the emergency room whose last visit was due to the seriousness of the medical problem, by year 

and selected characteristics: United States, 2013 and 2014

Selected demographic

2013 2014

Percent (standard error)

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76.1 (0.84) 77.1 (0.84)

Health insurance coverage status

Private . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77.2 (1.13) 78.4 (1.12)

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77.3 (1.76) 77.4 (1.55)

Uninsured . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.1 (1.86) 72.4 (2.30)

Age group

18–29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71.5 (1.66) 73.7 (1.70)

30–44. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74.1 (1.46) 76.8 (1.46)

45–64. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80.7 (1.09) 79.8 (1.19)

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74.4 (1.32) 78.0 (1.30)

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77.3 (0.97) 76.5 (1.04)

Race and ethnicity

Non-Hispanic white . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76.8 (1.07) 77.6 (1.12)

Non-Hispanic black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.2 (1.96) 73.0 (1.94)

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77.1 (1.80) 80.6 (1.69)

Residence

Metropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77.5 (0.90) 78.5 (0.90)

Nonmetropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68.9 (2.37) 70.4 (2.15)

NOTES: Seriousness of the medical problem was based on a positive response to at least one of the following reasons: health provider advised to go, problem was too serious for the doctor’s office 

or clinic, only a hospital could help, or arrived by ambulance or other emergency vehicle. Adults with unknown health insurance coverage status are included in the totals. Adults who are of race and 

ethnicity groups other than non-Hispanic white, non-Hispanic black, and Hispanic are included in the totals but are not shown separately. 

SOURCE: CDC/NCHS, National Health Interview Survey, 2013–2014.
National Health Statistics Reports  Number 90  February 18, 2016 Page 13

Table 3. Adults aged 18–64 with a visit to the emergency room whose last visit was due to the doctor’s office not being open, by year and 

selected characteristics: United States, 2013 and 2014

Selected demographic

2013 2014

Percent (standard error)

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.8 (0.68) 11.8 (0.63)

Health insurance coverage status

Private . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.8 (0.88) 12.0 (0.85)

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.2 (1.54) 12.1 (1.16)

Uninsured . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.0 (1.18) 9.8 (1.58)

Age group

18–29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.8 (1.31) 13.0 (1.20)

30–44. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.6 (1.21) 12.3 (1.17)

45–64. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.9 (0.90) 10.6 (0.88)

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.5 (1.02) 9.9 (0.89)

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.1 (0.83) 13.3 (0.83)

Race and ethnicity

Non-Hispanic white . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.6 (0.91) 12.5 (0.86)

Non-Hispanic black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.9 (1.24) 12.3 (1.35)

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.8 (1.38) 9.5 (1.31)

Residence

Metropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.6 (0.70) 10.7 (0.65)

Nonmetropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.0 (1.99) 17.4 (1.83)

NOTES: For this response option, doctor’s office or clinic was not open was selected and none of the reasons related to seriousness of the medical problem were selected. Adults with unknown health 

insurance coverage status are included in the totals. Adults who are of race and ethnicity groups other than non-Hispanic white, non-Hispanic black, and Hispanic are included in the totals but are not 

shown separately. 

SOURCE: CDC/NCHS, National Health Interview Survey, 2013–2014.
Page 14 National Health Statistics Reports  Number 90  February 18, 2016

Table 4. Adults aged 18–64 with a visit to the emergency room whose last visit was due to reasons of lack of access to other providers, by 

year and selected characteristics: United States, 2013 and 2014

2013 2014

Selected demographic Percent (standard error)

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.8 (0.50) 7.0 (0.50)

Health insurance coverage status

Private . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7 (0.65) 4.8 (0.58)

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7 (0.93) 7.5 (1.06)

Uninsured . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.8 (1.39) 15.4 (1.83)

Age group

18–29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.9 (1.15) 9.8 (1.27)

30–44. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.8 (0.81) 7.4 (0.86)

45–64. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.7 (0.63) 4.8 (0.59)

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.3 (0.83) 7.8 (0.84)

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7 (0.61) 6.4 (0.58)

Race and ethnicity

Non-Hispanic white . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.9 (0.63) 6.0 (0.59)

Non-Hispanic black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.1 (1.41) 10.3 (1.33)

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.3 (1.15) 6.2 (1.05)

Residence

Metropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.8 (0.55) 6.8 (0.57)

Nonmetropolitan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.9 (1.20) 8.0 (1.12)

NOTES: Lack of access to other providers was based on a positive response to at least one of the following: didn’t have another place to go, emergency room is the closest provider, or get most of care 

at the emergency room. This category excludes those who selected reasons related to seriousness of the medical problem or doctor’s office or clinic was not open. Adults with unknown health 

insurance coverage status are included in the totals. Adults who are of race and ethnicity groups other than non-Hispanic white, non-Hispanic black, and Hispanic are included in the totals but are not 

shown separately. 

SOURCE: CDC/NCHS, National Health Interview Survey, 2013–2014.
Table 5. Adjusted odds ratios for any ER visit and reason for last ER visit among adults aged 18–64 with a visit to the emergency room: 

United States, 2013 and 2014

Any ER visit Reason for visit

Seriousness1 Doctor’s office not open2 Lack of access3

Selected characteristic Odds ratio 95% CI Odds ratio 95% CI Odds ratio 95% CI Odds ratio 95% CI

Health insurance coverage status

Private4 . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 ... 1.00 ... 1.00 ... 1.00 ...

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . †

3.65 3.06–4.36 †1.59 1.18–2.15 †0.55 0.39–0.78 1.16 0.67–2.00

Uninsured . . . . . . . . . . . . . . . . . . . . . . . . 1.13 0.95–1.34 †

0.70 0.51–0.95 †0.62 0.40–0.98 †2.44 1.64–3.64

Other coverage . . . . . . . . . . . . . . . . . . . . ... ... 0.76 0.56–1.03 †

1.46 1.03–2.07 1.24 0.67–2.29

Year

20134 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.00 ... 1.00 ... 1.00 ... 1.00 ...

2014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.97 0.92–1.04 1.05 0.92–1.19 0.90 0.77–1.06 0.94 0.77–1.16

Age group

18–294

 . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... ... ... ... ... †1.91 1.45–2.50

30–44. . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... ... ... †

1.45 1.13–1.87 †1.40 1.08–1.81

45–64. . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... ... ... 1.00 ... 1.00 ...

Sex

Male4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... 1.00 ... 1.00 ... ... ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... 1.07 0.94–1.22 1.17 0.99–1.38 ... ...

Race and ethnicity

Non-Hispanic white4 . . . . . . . . . . . . . . . . ... ... 1.00 ... 1.00 ... ... ...

Non-Hispanic black . . . . . . . . . . . . . . . . . ... ... †

0.77 0.65–0.91 0.98 0.79–1.21 ... ...

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... 1.12 0.93–1.35 0.85 0.67–1.10 ... ...

Residence

Metropolitan4 . . . . . . . . . . . . . . . . . . . . . . 1.00 ... ... ... 1.00 ... 1.00 ...

Nonmetropolitan . . . . . . . . . . . . . . . . . . . †

1.18 1.08–1.30 ... ... †1.80 1.45–2.23 1.02 0.78–1.33

Selected interactions

Private, 18–29 vs. private, 45–64 . . . . . . . †

1.25 1.11–1.40 †0.76 0.61–0.95 1.10 0.83–1.44 ... ...

Medicaid, 18–29 vs. Medicaid, 45–64 . . . 0.95 0.82–1.17 †

0.37 0.26–0.52 †2.84 1.90–4.25 ... ...

Uninsured, 18–29 vs. uninsured, 45–64 . †

1.36 1.15–1.60 †0.69 0.50–0.96 1.48 0.86–2.55 ... ...

Private, female vs. private, male . . . . . . . †

1.17 1.08–1.27 ... ... ... ... †0.54 0.39–0.75

Medicaid, female vs. Medicaid, male . . . . †

1.41 1.21–1.63 ... ... ... ... 1.13 0.68–1.87

Uninsured, female vs. uninsured, male . . †

1.52 1.32–1.74 ... ... ... ... 0.88 0.64–1.21

Private, non-Hispanic black vs. private, 

non-Hispanic white . . . . . . . . . . . . . . . . . †

1.42 1.25–1.60 ... ... ... ... †2.03 1.33–3.11

Medicaid, non-Hispanic black vs. 

Medicaid, non-Hispanic white . . . . . . . . . 1.05 0.86–1.25 ... ... ... ... 0.71 0.43–1.18

Uninsured, non-Hispanic black vs. 

uninsured, non-Hispanic white. . . . . . . . . †

1.52 1.27–1.81 ... ... ... ... †2.08 1.35–3.21

Private, Hispanic vs. private, nonHispanic white . . . . . . . . . . . . . . . . . . . . . 0.93 0.82–1.04 ... ... ... ... 0.60 0.35–1.03

Medicaid, Hispanic vs. Medicaid, nonHispanic white . . . . . . . . . . . . . . . . . . . . . †

0.63 0.53–0.76 ... ... ... ... 0.61 0.35–1.06

Uninsured, Hispanic vs. uninsured, nonHispanic white . . . . . . . . . . . . . . . . . . . . . †

0.64 0.55–0.76 ... ... ... ... 0.89 0.56–1.40

Private, nonmetropolitan vs. private, 

metropolitan . . . . . . . . . . . . . . . . . . . . . . . ... ... †

0.57 0.45–0.72 ... ... ... ...

Medicaid, nonmetropolitan vs. Medicaid, 

metropolitan . . . . . . . . . . . . . . . . . . . . . . . ... ... †

0.56 0.42–0.76 ... ... ... ...

Uninsured, nonmetropolitan vs 

uninsured, metropolitan . . . . . . . . . . . . . . ... ... 0.85 0.60–1.23 ... ... ... ...

... Category not applicable.

†

Significantly different from reference (p < 0.05).

1

Reasons related to seriousness were based on a positive response to at least one of the following reasons: health provider advised to go, problem was too serious for the doctor’s office or clinic, only 

a hospital could help, or arrived by ambulance or other emergency vehicle.

2

The reason doctor’s office or clinic was not open was selected, and any reasons related to seriousness were not selected.

3

Reasons related to access were based on a positive response to at least one of the following: didn’t have another place to go, emergency room is the closest provider, or get most of care at the 

emergency room. Groups are mutually exclusive from those that selected reasons related to seriousness or doctor’s office or clinic was not open.

4

Reference group.

NOTES: Adults with other types of health insurance coverage and adults of other non-Hispanic races are included in the model, but results for these groups are not shown separately. ER is emergency 

room; CI is confidence interval.

SOURCE: CDC/NCHS, National Health Interview Survey, 2013–2014.

National Health Statistics Reports  Number 90  February 18, 2016 Page 15
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Suggested citation

Gindi RM, Black LI, Cohen RA. Reasons for 

emergency room use among U.S. adults aged 

18–64: National Health Interview Survey, 2013 

and 2014. National health statistics reports; no 

90. Hyattsville, MD: National Center for Health

Statistics. 2016.

Copyright information

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National Center for Health Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Nathaniel Schenker, Ph.D., Deputy Director

Jennifer H. Madans, Ph.D., Associate Director 

for Science

Division of Health Interview Statistics

Marcie L. Cynamon, Director

Stephen J. Blumberg, Ph.D., Associate Director 

for Science