安大略省和艾伯塔省儿科急诊就诊的地理不平等：对 250 万次就诊的多层次分析。
Geographic inequalities in paediatric emergency department visits in Ontario and Alberta: a multilevel analysis of 2.5 million visits.
机构信息
Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
Department of Paediatrics, Western University, London, ON, Canada.
出版信息
BMC Pediatr. 2022 Jul 20;22(1):432. doi: 10.1186/s12887-022-03485-x.
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. Our objectives were to assess intra-urban and inter-urban variation in paediatric 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 of 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 415.4 per 1,000 children population. Across CMAs, the crude rate of PED visits was highest in Thunder Bay, Ontario (771.6) and lowest in Windsor, Ontario (237.2). There was evidence of substantial intra- and inter-urban variation in the rates of PED visits. More socially deprived FSAs, FSAs with decreased 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 be fully 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.
背景
研究儿童在急诊部（ED）就诊的城乡内和城乡间差异可以更好地了解 ED 利用模式，并进一步了解城市环境的背景特征如何与这些健康事件相关联。我们的目标是评估安大略省和艾伯塔省的加拿大都会区（CMA）内城和城际之间儿科急诊部（PED）就诊的差异，并探讨与物质和社会贫困、医疗设施接近程度以及家庭医生供应相关的背景因素是否可以解释这种差异。
方法
我们对 2015 年 4 月 1 日至 2017 年 3 月 31 日期间记录的 PED 就诊数据进行了回顾性、基于人群的分析。我们构建了随机截距多水平回归模型，以量化 PED 就诊率的城乡内（FSAs 之间）和城乡间（CMAs 之间）差异。
结果
研究共纳入了 2537442 次 PED 就诊。总体而言，FSAs 儿童人口的 PED 就诊粗率为每 1000 人 415.4 次。在 CMAs 中，安大略省 Thunder Bay 的 PED 就诊粗率最高（771.6），而安大略省温莎的 PED 就诊粗率最低（237.2）。在 PED 就诊率方面存在显著的城乡内和城乡间差异。社会资源较匮乏的 FSAs、医疗设施接近程度较低的 FSAs 以及每 1000 名儿童的家庭医生数量较高的 CMA 具有较高的 PED 就诊率。
结论
CMAs 和 FSAs 之间 PED 就诊率的差异不能完全由年龄和性别分布、物质和社会贫困、医疗设施接近程度或家庭医生的供应来解释。需要探索其他背景因素，以更好地了解为什么一些大都市地区的 PED 就诊率较高。
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