Emergency department (ED) use ratios were calculated using the State Inpatient Databases and State Emergency Department Databases from the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality. The data, which was publicly available available for 33 states, is limited to patients treated in hospital-owned EDs of community hospitals in the state. For each state, the total number of ED visits was divided by the U.S. Census population estimate for that state. All data is from 2016.

The analysis used data from the The HOPE Initiative for state performance on the 28 indicators of the social determinants of health. The HOPE Initiative, from the National Collaborative for Health Equity, “tracks 28 indicators that span the life course, including health outcomes and indicators related to opportunity such as socioeconomic factors, the physical and social environment, and access to health care at the state and national level.”

Correlation coefficients reflect the relationship between ED use ratio and state performance on each individual indicator for the five states with the highest ratio and five states with the lowest ratio. The coefficient values range from minus 1.0 to plus 1.0, where minus 1 indicates the strongest possible negative relationship and plus 1 indicates the strongest possible positive relationship.

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