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

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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.

Résumé

Objectifs

Déterminer l’association entre la marginalisation du quartier et les taux de visites aux urgences pédiatriques à Ottawa, en Ontario. Les objectifs secondaires visaient à déterminer si l’association entre la marginalisation du quartier et les taux variait selon l’année, l’acuité et la distance à l’hôpital.

Méthodes

Nous avons calculé les taux de visites aux urgences pédiatriques par tranche de 1000 années-personnes dans les aires de diffusion du recensement à moins de 100 km du Centre hospitalier pour enfants de l’est de l’Ontario pour les patients de moins de 18 ans de janvier 2018 à décembre 2020. L’Indice de marginalisation de l’Ontario de 2016 classait les quartiers selon des quintiles d’instabilité résidentielle, de privation matérielle, de concentration ethnique et de dépendance. Les modèles à effets mixtes généralisés ont déterminé les ratios des taux d’incidence des visites aux urgences pédiatriques pour chaque quintile de marginalisation; des modèles multivariés ont été utilisés pour contrôler l’année de présentation et la distance à l’hôpital. L’analyse a été répétée pour les visites à l’urgence de faible acuité par rapport à haute acuité.

Résultats

Il y a eu 154 146 visites aux urgences de patients dans 2 055 aires de diffusion du recensement à moins de 100 km du CHEO de 2018 à 2020. Après avoir tenu compte de l’année et de la distance par rapport à l’hôpital dans les analyses multivariées, on a constaté des taux plus élevés de visites aux urgences pédiatriques dans les zones de diffusion présentant une instabilité résidentielle élevée, une privation matérielle élevée et une faible concentration ethnique. Ces résultats n’ont pas changé selon l’acuité de la visite.

Conclusions

L’instabilité résidentielle du quartier et la privation matérielle doivent être prises en compte lors de la recherche de solutions de rechange aux soins d’urgence.

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Authors and Affiliations

  1. Children’s Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada

    Habeeb AlSaeed, Maala Bhatt, Natalie Bresee & Melanie Bechard

  2. University of Ottawa, Ottawa, ON, Canada

    Habeeb AlSaeed, Maala Bhatt, Natalie Bresee & Melanie Bechard

  3. Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada

    Ewa Sucha & Nicholas Mitsakakis

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  1. Habeeb AlSaeed
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Correspondence to Melanie Bechard.

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AlSaeed, H., Sucha, E., Bhatt, M. et al. Rates of pediatric emergency department visits vary according to neighborhood marginalization in Ottawa, Canada. Can J Emerg Med 26, 119–127 (2024). https://doi.org/10.1007/s43678-023-00625-9

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  • DOI: https://doi.org/10.1007/s43678-023-00625-9

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