Racial differences in the burden of cardiovascular disease contribute significantly to health dispairities observed in the United States. Timely access to emergency care is critical for diseases such as acute myocardial infarction (AMI) and congestive heart failure (CHF), yet access to emergency departments (EDs) varies substantially across communities. The deterioration of ED access, due to either closure or crowding (henceforth "ED access block"), is associated with increased mortality rates. It has been posited that ED closures may improve acute care by removing poor-performers in a competitive market such that there is a tradeoff between distance traveled and quality of care. The risk of this assumption however, is that if ED closures occur mainly in minority communities, there could be differential effects. We seek to fill this gap in the literature.
The objective of the research is to determine whether emergency department closures or crowding widens racial disparities in access and outcomes at patient-, facility-, and community-levels; and whether improved access as a result of ED opening can reduce such disparities. Health policies aiming to improve efficiency of care delivery can have unintended consequences of widening health disarities. Our results will offer an unusually complete picture of the potential mechanisms through which disparities can occur.