Behavioral Health, Mental Health, Substance Abuse
Impact of Local Health Departments on Racial and Ethnic Disparities in Emergency Visits for Behavioral Health Disorders
(School of Public Health (UMD) HLSA Doctoral Student)
Objectives: The purpose of this study is to develop a conceptual framework delineating the impact of local health departments (LHDs) on racial and ethnic disparities in behavioral health disorders (BHDs) in Maryland. BHDs of racial and ethnic minorities are significantly undertreated, and LHDs are well positioned to address BHD needs. Methods: Using data for the state of Maryland from the Health Cost and Utilization Project (HCUP) State Emergency Department Database (2012), the National Association of County and City Health Officials (NACCHO) National Profile of Local Health Departments Survey (2013), and Area Health Resource File (2013-2014), we use multivariate regression models to examine whether LHD involvement in BHD-related policy, prevention, and treatment are associated with lower rates of BHD-related ED visits in Maryland, controlling for county-, LHD-, and individual-level variables. We also construct interaction terms to examine the relationship between LHD involvement and race. Our sample consists of 1,642,429 ED visits of adults in the state of Maryland in 2012, 416,529 (25.36%) of which were BHD-related. Results: We find LHD involvement in BHD-related policy (OR = 0.87, p < 0.001) significantly decrease the probability of having a BHD-related ED visit. Models including interaction terms indicate that there are significant differences by race in how LHD involvement in BHD-related policy affects the probability of having a BHD-related ED visit. Conclusions: Maryland LHDs play a vital role in assessing BHD prevalence, incidence, and treatment needs, educating and activating the community to address BHD, and providing valuable referral to appropriate treatment. Our findings indicate potential racial/ethnic disparities in how LHD involvement affects BHD in the community. More research is needed to validate these findings on a national level.