Health disparities in emergency department patients with severe mental illness and non-traumatic hollow organ perforation

Background: Patients with severe mental illness (SMI) face substantial health disparities and a higher burden of physical comorbidities. This study investigates whether disparities exist in emergency department (ED) care and outcomes for SMI patients presenting with non-traumatic hollow organ perforation in a healthcare system with universal coverage. Methods: We conducted a retrospective matched case-control study using data from seven major hospitals in Taiwan between 2007 and 2017. Patients with SMI were identified through psychiatric diagnoses prior to their index admission. After matching by age and gender, we compared ED treatment timelines, in-hospital outcomes, and expenditures between SMI and non-SMI patients. Results: Of the 25,893 overall patients, 7563 were included in the analysis. After matching for age and gender, a total of 92 SMI and 276 matched non-SMI patients were analyzed. There were no significant differences in presenting vital signs, laboratory tests, ED management, and mortality between the SMI and non-SMI groups. Also, no significant differences were found in ED treatment variables, including analgesic use and time to surgery. However, SMI patients experienced longer hospital stays (16.9 vs. 13.0 days, p = 0.02) and higher in-hospital expenditures (5752.6 vs. 4141.3 USD, p = 0.04). SMI remained an independent predictor of prolonged hospitalization in multivariable analysis. The SMI group exhibited higher rates of comorbidities and more severe Charlson Comorbidity Index stages. Conclusions: In a system with high healthcare accessibility, ED care for SMI patients with surgical emergencies appears equitable. Nonetheless, longer hospitalizations and increased costs suggest a need for tailored, multidisciplinary strategies to address the complex needs of SMI patients beyond the ED setting.

Severe mental illness; Non-traumatic hollow organ perforation; Health disparity; Emergency department

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