Sheriff Falana, Agarwal Amisha, Thipse Madhura, Radhakrishnan Dhenuka
Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
J Asthma. 2022 May;59(5):880-889. doi: 10.1080/02770903.2021.1887891. Epub 2021 Mar 1.
Pediatric asthma emergency department (ED) visits and repeat visits place a substantial burden on healthcare. National and provincial level studies demonstrate geographic variation in asthma ED visits and links to marginalization, but preclude translation into practical targeting of healthcare delivery. It is important to understand the relationship between pediatric asthma ED visits and marginalization at a more granular level. To map the city-level geographic variation in pediatric asthma ED visit and re-visit rates at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa, Canada and the relationship with marginalization.
We performed a single center retrospective cohort study of children ages 1-17 with one or more ED visits for asthma at the CHEO in Ottawa. Using postal codes, we linked patients to census tracts. Per census tract, we mapped pediatric asthma ED visit and re-visit rates within one year and identified overlap with the Ontario Marginalization Index.
Of 1,620 children with an index ED visit, 18.5% had a repeat ED visit. We identified 10 hot spot census tracts each for pediatric asthma ED visit and re-visit rates. We identified an overlap between urban hot spots and areas with high ethnic concentration or low dependency.
At a granular, city-wide level, pediatric asthma ED visit and re-visit rates are heterogeneous. Urban hot spots, in contrast to rural, have more overlap with marginalization, especially ethnic concentration. These methods can be used in other jurisdictions to inform practical community strategies for geographically-targeted prevention of pediatric asthma-related ED visits in vulnerable areas.Abbreviations:ED:Emergency department;CHEO:Children's Hospital of Eastern Ontario;PRAM:Pediatric Respiratory Assessment Measure;ON-Marg:Ontario Marginalization Index;SES:Socioeconomic status;US:United States.
Supplemental data for this article can be accessed at publisher's website.
儿科哮喘急诊就诊和复诊给医疗保健带来了沉重负担。国家和省级层面的研究表明哮喘急诊就诊存在地域差异且与边缘化有关联，但无法转化为针对医疗服务提供的实际目标定位。在更细化层面了解儿科哮喘急诊就诊与边缘化之间的关系很重要。绘制加拿大渥太华东安大略儿童医院（CHEO）儿科哮喘急诊就诊和复诊率的城市层面地域差异图以及与边缘化的关系。
我们对渥太华CHEO有过一次或多次哮喘急诊就诊的1至17岁儿童进行了单中心回顾性队列研究。利用邮政编码，我们将患者与普查区关联起来。对于每个普查区，我们绘制了一年内儿科哮喘急诊就诊和复诊率，并确定与安大略边缘化指数的重叠情况。
在1620名首次急诊就诊的儿童中，18.5%进行了复诊。我们分别确定了儿科哮喘急诊就诊和复诊率的10个热点普查区。我们发现城市热点地区与种族集中度高或依赖度低的地区存在重叠。
在城市全范围的细化层面，儿科哮喘急诊就诊和复诊率存在异质性。与农村地区相比，城市热点地区与边缘化的重叠更多，尤其是种族集中度方面。这些方法可用于其他司法管辖区，为在脆弱地区针对儿科哮喘相关急诊就诊进行地理定位预防的实际社区策略提供信息。缩写：ED：急诊科；CHEO：东安大略儿童医院；PRAM：儿科呼吸评估量表；ON-Marg：安大略边缘化指数；SES：社会经济地位；US：美国。
本文的补充数据可在出版商网站获取。
