Geographic Inequalities of Respiratory Health Services Utilization during Childhood in Edmonton and Calgary, Canada: A Tale of Two Cities

Serrano-Lomelin, Jesús; Nielsen, Charlene C.; Hicks, Anne; Crawford, Susan; Bakal, Jeffrey A.; Ospina, Maria

doi:10.3390/ijerph17238973

Cited by 7 publications

(14 citation statements)

References 47 publications

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“…The material and social deprivation components of the Index are reported in quintiles, where Q 1 and Q 5 correspond to the least and most deprived groups, respectively. The six-character maternal postal codes at delivery were geographically linked to the dissemination areas (which are a conglomerate of postal codes), as reported elsewhere [ 38 ].…”

Section: Methodsmentioning

confidence: 99%

Patterns of respiratory health services utilization from birth to 5 years of children who experienced adverse birth outcomes

et al. 2021

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Introduction Adverse birth outcomes have important consequences for future lung health. We evaluated patterns of respiratory health services utilization in early childhood among children born preterm (PTB), small and large for gestational age at term (SGA and LGA, respectively), and appropriate-for-gestational age at term. Materials and methods We conducted a population-based retrospective cohort study using administrative health data of all singleton live births in Alberta, Canada between 2005–2010. Data on hospitalizations and emergency department (ED) visits from birth to 5 years were collected for asthma, bronchitis, bronchiolitis, croup, influenza, pneumonia, and other acute upper and lower respiratory tract infections (other URTI and other LRTI, respectively). Adjusted rate ratios were estimated for respiratory ED visits and hospitalizations for adverse birth outcomes using the appropriate-for-gestational age at term group as reference. Age-specific trajectories of total respiratory health services utilization rates for each group were estimated in Poisson models. Results A total of 293,764 episodes of respiratory care from 206,994 children were analyzed. Very PTB children had the highest rates of health services use for all respiratory conditions, particularly for asthma, pneumonia, and bronchiolitis hospitalizations. Moderate/late PTB children also had elevated ED visits and hospitalizations for all respiratory conditions. Children born SGA showed high rates of ED visits for other LRTI, and of hospitalizations for bronchitis, bronchiolitis, and other URTI. Children born LGA had high rates of croup and other URTI ED visits, and of bronchiolitis and bronchiolitis hospitalizations. Age-specific trajectories showed a decreasing trend in the rates of total respiratory health service utilization from birth to five years of age for all groups studied. Children born PTB and LGA at term significantly required more respiratory health services over time compared to the reference group. Conclusion Patterns of paediatric respiratory health services utilization vary according to gestational age and fetal growth.

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Section: Methodsmentioning

confidence: 99%

Patterns of respiratory health services utilization from birth to 5 years of children who experienced adverse birth outcomes

et al. 2021

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“…The original study flow diagram, data sources, and demographic characteristics of the cohort have been described elsewhere [22,25,26]. Briefly, we obtained de-identified, individual-level data from administrative health databases (i.e., Discharge Abstracts Database and the National Ambulatory Care Reporting System) on all respiratory hospitalizations and ED visits occurring from birth until 5 years of age for every member of the cohort.…”

Section: Study Population and Data Sourcesmentioning

confidence: 99%

“…Recent studies have explored the intersections of geographic inequalities and pediatric respiratory illnesses in urban centers, noting discrepancies between various neighborhoods; however, little research has evaluated these factors across larger geographic regions, accounting for rural and remote communities [22]. The objective of this study was to explore the geographic inequalities in respiratory healthcare utilization during early childhood and potential links with economically or socially deprived populations in Alberta.…”

Section: Introductionmentioning

confidence: 99%

Geography as a Determinant of Health: Health Services Utilization of Pediatric Respiratory Illness in a Canadian Province

Kassam

Serrano-Lomelin

Hicks

et al. 2021

IJERPH

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Respiratory diseases contribute to high healthcare utilization rates among children. Although social inequalities play a major role in these conditions, little is known about the impact of geography as a determinant of health, particularly with regard to the difference between rural and urban centers. A regional geographic analysis was conducted using health repository data on singleton births between 2005 and 2010 in Alberta, Canada. Data were aggregated according to regional health sub-zones in the province and standardized prevalence ratios (SPRs) were determined for eight respiratory diseases (asthma, influenza, bronchitis, bronchiolitis, croup, pneumonia, and other upper and other lower respiratory tract infections). The results indicate that there are higher rates of healthcare utilization in northern compared to southern regions and in rural and remote regions compared to urban ones, after accounting for both material and social deprivation. Geography plays a role in discrepancies of healthcare utilization for pediatric respiratory diseases, and this can be used to inform the provision of health services and resource allocation across various regions.

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“…With approximately 70% of Canadians currently living in census metropolitan areas (CMAs) [5], it is important to understand the determinants of variations in PED visits within (intra-CMA variation) and across (inter-CMA variation) these metropolitan areas [6][7][8]. These intra-and inter-urban variations may arise from contextual factors such as differential distribution of primary healthcare physicians within and across urban centers [9,10], or proximity to healthcare facilities [11,12].…”

Section: Introductionmentioning

confidence: 99%

“…Currently, there is limited knowledge about geographic inequalities in PED visits in Canada's urban areas and the contribution of contextual factors to these inequalities, with most studies focusing on intra-urban variation in PED visits for respiratory conditions [6][7][8]. Therefore, this study aimed to quantify the magnitude of intra-metropolitan and inter-metropolitan variation in PED visits in large urban centers in Ontario and Alberta, Canada and assess if contextual factors related to material and social deprivation, proximity to healthcare facilities, and supply of family physicians can account for this variation.…”

Section: Introductionmentioning

confidence: 99%

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

Wilk

Maltby

Lau

et al. 2022

Preprint

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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.

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Geographic Inequalities of Respiratory Health Services Utilization during Childhood in Edmonton and Calgary, Canada: A Tale of Two Cities

Cited by 7 publications

References 47 publications

Patterns of respiratory health services utilization from birth to 5 years of children who experienced adverse birth outcomes

Patterns of respiratory health services utilization from birth to 5 years of children who experienced adverse birth outcomes

Geography as a Determinant of Health: Health Services Utilization of Pediatric Respiratory Illness in a Canadian Province

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

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