Emergency department utilization among deaf and hard-of-hearing patients: A retrospective chart review

Figure S1, Generic inverse variance pooled effects analysis for DHH ASL-user status on ED utilization in past 36-months from James et al., Disability and Health Journal.


Background. Deaf and hard-of-hearing (DHH) patients are an underserved priority population. Existing, although contextually limited, findings indicate that DHH patients are more likely to use the emergency department (ED) than non-DHH patients. However, little attention has been given to the differences in ED utilization by patients’ language modality. Objective/Hypothesis: We hypothesized that DHH ASL-users and DHH English-speakers would have higher rates of ED utilization in the past 36 months, than non-DHH English-speakers. Methods. We used a retrospective chart review design using data from a large academic medical center in the southeastern United States. In total, 277 DHH ASL-users, 1,000 DHH English-speakers, and 1,000 non-DHH English-speakers were included. We used logistic regression and zero-inflated modeling to assess relations between patient segment and ED utilization in the past 12- and 36-months. We describe primary ED visit diagnosis codes using AHRQ Clinical Classifications Software. Results. DHH ASL-users and DHH English-speakers had higher adjusted odds ratios of using the ED in the past 36-months than non-DHH English-speakers (aORs = 1.790 and 1.644, respectively). Both DHH ASL-users and DHH English-speakers had higher frequency of ED visits, among patients who used the ED in the past 36-months (61.0% and 70.1%, respectively). The most common principal diagnosis code was for abdominal pain, with DHH English-speakers making up over half of all abdominal pain encounters. Conclusions. DHH ASL-users and DHH English-speakers are at higher risk of using the ED compared to non-DHH English-speakers. We call for additional attention on DHH patients in health services and ED utilization research.

Disability and Health Journal


  • Is this paper peer reviewed? This paper is published in Disability and Health Journal. This journal uses double-blind peer review, where the authors and the reviewers do not know each other’s identities.

  • Who paid for this project? This project was supported by grant number R36HS027537 from the U.S. Agency for Healthcare Research and Quality (PI: T.G.J.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

  • Are there any conflicts of interest? There are no conflicts of interest.