Emergency department visits for ambulatory care sensitive conditions by persons with Rheumatoid Arthritis: A population-based study
Dani G. Contreras, Zanir Bhanji, J. Antonio Aviña-Zubieta, Claire E.H. Barber, Cheryl Barnabe
Abstract
We estimated emergency department (ED) visit rates for Canadian-indicator Ambulatory Care Sensitive Conditions (ACSCs) by persons with rheumatoid arthritis (RA) relative to age- and sex-matched general population controls.
Introduction
The consequences of systemic inflammation in Rheumatoid Arthritis (RA) are posited to lead to increased healthcare utilization, including emergency department (ED) visits, which drives healthcare system costs. In Alberta, persons with RA are overrepresented in ED utilization.
Materials and methods
Study Design: This was a retrospective cohort study using population-level administrative health data. In Alberta, a province of 4.6 million people, all health administrative data are maintained by Alberta Health for the Alberta Health Care Insurance Plan (AHCIP) and Alberta Health Services, as a single-payer health system.
Results
The incident cohort consisted of 52,596 individuals with RA, matched to 210,384 randomly selected individuals who did not meet the RA case definition. From the RA cohort, 68% (n = 35,770 individuals) had at least one ED visit for any reason up to five years after their index date.
Discussion
Our study contributes knowledge of ED utilization, and specifically ACSC-related healthcare utilization, by RA patients. Overall, individuals with RA more frequently attend the ED in the first five years following diagnosis as compared to their matched controls. Approximately 5% of these ED visits are potentially avoidable, and the proportion of visits for ACSCs has increased over the last decades.
Conclusion
Persons with RA are at a higher risk of avoidable ED visits 5 years after diagnosis, with ED use for ACSC higher than the control population, and increasing over time. Better access to and quality of ambulatory care, including primary and specialty care.
Citation: Contreras DG, Bhanji Z, Aviña-Zubieta JA, Barber CE, Barnabe C (2025) Emergency department visits for ambulatory care sensitive conditions by persons with Rheumatoid Arthritis: A population-based study. PLoS One 20(12): e0337003. https://doi.org/10.1371/journal.pone.0337003
Editor: David T. Zhu, Virginia Commonwealth University School of Medicine, UNITED STATES OF AMERICA
Received: August 5, 2025; Accepted: November 3, 2025; Published: December 10, 2025
Copyright: © 2025 Contreras et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: Supported by the Canadian Institutes of Health Research (CIHR) Project Grant Priority
Announcement: Institute of Musculoskeletal Health and Arthritis Mandate Areas (competition 202209, application number 485841), CIHR Canada Research Chairs Program (to Dr Barnabe, Tier 2, Rheumatoid Arthritis and Autoimmune Disease), and the Arthur J. E. Child Chair in Rheumatology Research with the McCaig Institute for Bone and Joint Health. There was no additional external funding received for this study.
Competing interests: The authors have declared that no competing interests exist.
