Geographic inequalities in pediatric emergency department visits in Ontario and Alberta: a multilevel analysis of 2.5 million visits

Abstract

Background: Research on intra- and inter-regional variations in emergency department (ED) visits among children can provide a better understanding of the patterns of ED utilization and further insight into how contextual features of the urban environment may be associated with these health events. To assess intra-urban and inter-urban variation in pediatric emergency department (PED) visits in census metropolitan areas (CMAs) in Ontario and Alberta, Canada and explore if contextual factors related to material and social deprivation, proximity to healthcare facilities, and supply to family physicians explain this variation.Methods: A retrospective, population-based analysis of data on PED visits recorded between April 1, 2015 and March 31, 2017 was conducted. Random intercept multilevel regression models were constructed to quantify the intra- (between forward sortation areas [FSAs]) and inter- (between CMAs) variations in the rates of PED visits.Results: In total, 2,537,442 PED visits were included in the study. The overall crude FSA-level rate of PED visits was 415.38 per 1,000 children population. Across both provinces’ CMAs, the crude rate of PED visits was highest in Thunder Bay, Ontario (771.65) and lowest in Windsor, Ontario (237.19). There was evidence of statistically significant and substantial intra- and inter-urban variation in the rates of PED visits. More socially deprived FSAs, FSAs with lower proximity to healthcare facilities, and CMAs with a higher rate of family physicians per 1,000 children population had higher rates of PED visits.Conclusions: The variation in rates of PED visits across CMAs and FSAs cannot fully be accounted for by age and sex distributions, material and social deprivation, proximity to healthcare facilities, or supply of family physicians. There is a need to explore additional contextual factors to better understand why some metropolitan areas have higher rates of PED visits.