Longitudinal trajectories and persistence of frequent emergency department use: A two-year individual-level cohort study
Abstract
INTRODUCTION: Whether frequent emergency department (ED) use (≥4 ED visits per calendar year) reflects a persistent patient phenotype or predominantly transient episodes remains unknown in France. This study characterised longitudinal trajectories and predictors of persistence, lack of primary care affiliation and very frequent use (VFU). METHODS: Two-year retrospective cohort study at a French tertiary-care university hospital (2023-2024). Individual patient-level linkage classified patients as persistent, incident, or remitting frequent users. Forced-entry multivariable logistic regression identified predictors of persistence, lack of primary care affiliation, and VFU (≥6 visits/year). RESULTS: Linkage identified 196 persistent users (16.7% of 2023 frequent ED users), 982 incident, and 976 remitting. Persistent users were younger (49.3 vs 55.4 years; p = 0.001) and more often in the ≥6 visits/year stratum (51.5%vs 24.9%; p < 0.001). Persistence increased steeply with index-year visit intensity (adjusted OR 8.78 for ≥10 vs 4 visits/year). Repeat attendance was mostly for differing reasons (identical chief complaint at every visit: 1.9%). Mental-health, haematological, and addiction-related presentations were over-represented among VFU. Lack of primary care affiliation was predicted by male sex (aOR = 2.25) and younger age (aOR = 0.97/year), and was higher among out-of-catchment patients (28.1%vs 13.5%; p = 0.002). CONCLUSIONS: Frequent ED use was predominantly transient, with only 16.7% of patients remaining frequent users across consecutive years; persistent users were younger and concentrated in the highest-use stratum. Lack of primary care affiliation reflected sociodemographic factors (male sex, younger age). These findings identify persistent users as a priority target for future coordinated interventions.
Related
- Persistence of bounded trajectories in positively transverse reaction networks
- Bedtime rumination mediates the burnout-insomnia link and relates to shift adaptation in emergency department staff
- Emergency Department Clinicians' Needs for User-Centered Antibiotic Guideline: Insights from a Focus Group Interview.
- From Individual Trajectories to Population Densities: Weak-Form Inference of Heterogeneous Growth Laws
- Characterizing Individual and Population-Level Heterogeneity in Infant BMI Trajectories Using Flexible and Functional Modeling Approaches
BibTeX
@article{taheri2026longitudinal,
title = {{Longitudinal trajectories and persistence of frequent emergency department use: A two-year individual-level cohort study}},
author = {Omide Taheri and Pierrick Le Borgne and Charlène Duchanois and Tahar Chouihed and Stéphane Gennai},
journal = {Journal of Epidemiology and Population Health},
year = {2026},
month = nov,
doi = {10.1016/j.jeph.2026.203810},
url = {https://univ-reims.hal.science/hal-05851515v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Longitudinal trajectories and persistence of frequent emergency department use: A two-year individual-level cohort study
AU - Omide Taheri
AU - Pierrick Le Borgne
AU - Charlène Duchanois
AU - Tahar Chouihed
AU - Stéphane Gennai
PY - 2026
DA - 2026/11/04
JO - Journal of Epidemiology and Population Health
DO - 10.1016/j.jeph.2026.203810
UR - https://univ-reims.hal.science/hal-05851515v1
AB - INTRODUCTION: Whether frequent emergency department (ED) use (≥4 ED visits per calendar year) reflects a persistent patient phenotype or predominantly transient episodes remains unknown in France. This study characterised longitudinal trajectories and predictors of persistence, lack of primary care affiliation and very frequent use (VFU). METHODS: Two-year retrospective cohort study at a French tertiary-care university hospital (2023-2024). Individual patient-level linkage classified patients as persistent, incident, or remitting frequent users. Forced-entry multivariable logistic regression identified predictors of persistence, lack of primary care affiliation, and VFU (≥6 visits/year). RESULTS: Linkage identified 196 persistent users (16.7% of 2023 frequent ED users), 982 incident, and 976 remitting. Persistent users were younger (49.3 vs 55.4 years; p = 0.001) and more often in the ≥6 visits/year stratum (51.5%vs 24.9%; p < 0.001). Persistence increased steeply with index-year visit intensity (adjusted OR 8.78 for ≥10 vs 4 visits/year). Repeat attendance was mostly for differing reasons (identical chief complaint at every visit: 1.9%). Mental-health, haematological, and addiction-related presentations were over-represented among VFU. Lack of primary care affiliation was predicted by male sex (aOR = 2.25) and younger age (aOR = 0.97/year), and was higher among out-of-catchment patients (28.1%vs 13.5%; p = 0.002). CONCLUSIONS: Frequent ED use was predominantly transient, with only 16.7% of patients remaining frequent users across consecutive years; persistent users were younger and concentrated in the highest-use stratum. Lack of primary care affiliation reflected sociodemographic factors (male sex, younger age). These findings identify persistent users as a priority target for future coordinated interventions.
SN - 2950-4333
SN - 2950-4333
ER -