Rates of pediatric emergency department visits vary according to neighborhood marginalization in Ottawa, Canada

IF 2 4区 医学 Q2 EMERGENCY MEDICINE Canadian Journal of Emergency Medicine Pub Date : 2023-12-20 DOI:10.1007/s43678-023-00625-9
Habeeb AlSaeed, Ewa Sucha, Maala Bhatt, Nicholas Mitsakakis, Natalie Bresee, Melanie Bechard
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Abstract

Objectives

To determine the association between neighborhood marginalization and rates of pediatric ED visits in Ottawa, Ontario. Secondary objectives investigated if the association between neighborhood marginalization and rates varied by year, acuity, and distance to hospital.

Methods

We calculated rates of pediatric ED visits per 1000 person-years for census dissemination areas within 100 km of the Children’s Hospital of Eastern Ontario for patients < 18 years old from January 2018 through December 2020. The 2016 Ontario Marginalization Index categorized neighborhoods along quintiles of residential instability, material deprivation, ethnic concentration, and dependency. Generalized mixed-effects models determined the incidence rate ratios of pediatric ED visits for each quintile of marginalization; multivariate models were used to control for year of presentation and distance to hospital. Analysis was repeated for low versus high acuity ED visits.

Results

There were 154,146 ED visits from patients in 2055 census dissemination areas within 100 km of CHEO from 2018 to 2020. After controlling for year and distance from hospital in multivariate analyses, there were higher rates of pediatric ED visits for dissemination areas with high residential instability, high material deprivation, and low ethnic concentration. These findings did not change according to visit acuity.

Conclusions

Neighborhood residential instability and material deprivation should be considered when locating alternatives to emergency care.

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加拿大渥太华儿科急诊就诊率因社区边缘化程度而异
目标确定安大略省渥太华市邻里边缘化与儿科急诊室就诊率之间的关系。次要目标是调查邻里边缘化与就诊率之间的关系是否因年份、严重程度和医院距离而异。方法我们计算了2018年1月至2020年12月期间,东安大略省儿童医院100公里范围内人口普查分布区每1000人年的儿科急诊室就诊率,患者年龄为18岁。2016 年安大略省边缘化指数按照居住不稳定性、物质匮乏、种族集中和依赖性的五分位数对社区进行了分类。广义混合效应模型确定了每个边缘化五分位数的儿科急诊就诊发生率比;多变量模型用于控制发病年份和医院距离。结果从2018年到2020年,CHEO 100公里范围内2055个人口普查传播区域的患者共就诊154146次。在多变量分析中控制了年份和与医院的距离后,居住不稳定性高、物质匮乏程度高和民族聚集程度低的传播区的儿科急诊就诊率较高。结论在选择急诊替代方案时,应考虑居民区的不稳定性和物质匮乏。
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来源期刊
Canadian Journal of Emergency Medicine
Canadian Journal of Emergency Medicine Medicine-Emergency Medicine
CiteScore
2.90
自引率
12.50%
发文量
171
审稿时长
>12 weeks
期刊介绍: CJEM is a peer-reviewed journal owned by CAEP. CJEM is published every 2 months (January, March, May, July, September and November). CJEM presents articles of interest to emergency care providers in rural, urban or academic settings. Publishing services are provided by the Canadian Medical Association.
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