Negative illness feedbacks: High-frisk policing reduces civilian reliance on ED services

Abstract

Objective: This paper demonstrates that localized and chronic stop-question-and-frisk (SQF) practices are associated with community members’ utilization of emergency department (ED) resources. To explain this relationship, we explore the empirical applicability of a legal epidemiological framework, or the study of legal institutional influences on the distribution of disease and injury. Data and Study Design: Analyses are derived from merging data from the Philadelphia Vehicle and Pedestrians Investigation, the National Historical Geographic Information System, and the Southeastern Philadelphia Community Health database to zip code identifiers common to all datasets. Weighted multilevel negative binomial regressions measure the influence that local SQF practices have on ED use for this population. Analytic methods incorporate patient demographic covariates including household size, health insurance status, and having a doctor as a usual source of care. Principal Findings: Findings reveal that both tract-level frisking and poor health are linked to more frequent use of hospital EDs, per respondent report. Despite their health care needs, however, reporting poor/fair health status is associated with a substantial decrease in the rate of emergency department visits as neighborhood frisk concentration increases (IRR = 0.923; 95% CI: 0.891, 0.957). Moreover, more sickly people in high-frisk neighborhoods live in tracts that have greater racial disparities in frisking—a pattern that accounts for the moderating role of neighborhood frisking in sick people's usage of the emergency room. Conclusions: Findings indicating the robust association reported above interrogate the chronic incompatibility of local health and human service system aims. The study also provides an interdisciplinary theoretical lens through which stakeholders can make sense of these challenges and their implications.