Smokers are four times more likely than non-smokers to become frequent visitors of emergency rooms.

That is one of the findings uncovered by a preliminary study led by Jessica Castner, a University at Buffalo emergency room utilization researcher.

The research -- which sought to shed light on whether patients are replacing visits to their primary care physicians with trips to hospital ERs- also found that Americans with chronic diseases use both services equally and that, overall, medical care visits have soared in recent years.

"There are a few super-users who have been in the ER 40 or 50 times, but when we step back and look at the whole population, we see a different pattern," says Castner, assistant professor in the UB School of Nursing. "People aren't replacing their doctor; they are sicker, have more chronic diseases and are using everything more."

Castner received a 2015 Junior Doctoral Award in Health Systems and Informatics Research from the Midwest Nursing Research Society last month for her research.

The study, "Frequent Emergency Department Utilization and Behavioral Health Diagnosis," was published earlier this year in Nursing Research, a publication of the Eastern Nursing Research Society.

Emergency department use could increase as more individuals gain health insurance coverage under the Affordable Care Act, placing a financial strain on health insurers, patients and the overall health care system, says Castner.

The study analyzed Department of Health data from 2009 of 56,000 people between the ages of 18-64 who used Medicaid to cover their medical expenses.

Patients were divided into four categories: healthy; at risk for chronic disease; diagnosed with chronic disease; and diagnosed with a system failure, such as kidney or heart failure.

According to the results, those with chronic diseases weren't the only high volume users of the ER; similar to smoking's effect, substance abuse and psychiatric illnesses tripled a patient's likelihood of becoming a "frequent ER user," -- visiting the ER three or more times a year.

Future studies will reanalyze emergency department use with focuses on specific chronic conditions.