Ohanian Ruben, Serrano-Lomelin Jesus, Rowe Brian H, Crawford Susan, Jelinski Susan, Ospina Maria B
Department of Public Health Sciences, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
Department of Emergency Medicine, Faculty of Medicine & Dentistry; and School of Public Health, both in the College of Health Science, University of Alberta, Edmonton, AB, Canada.
CJEM. 2025 Jun 4. doi: 10.1007/s43678-025-00945-y.
To assess inequalities in emergency department utilization during the perinatal period across socioeconomic and rural-urban gradients in Alberta, Canada.
We conducted a secondary analysis of a population-based cohort study of live-birth pregnancies in Alberta between 2011 and 2017. Emergency department visits during pregnancy and up to 1-year postpartum were analyzed. Socioeconomic position was assessed using 25 combined groups derived from quintiles of material and social deprivation. Rural-urban residence was categorized into seven geographic groups based on Alberta Health Services' classification. Concentration indexes quantified inequalities in emergency department utilization, categorized as low (≤ 0.05), medium (0.06-0.19), or high (≥ 0.20). Multilevel negative binomial regression models estimated adjusted rate ratios and 95% confidence intervals to measure differences in emergency department visit rates across socioeconomic and rural-urban groups, accounting for individual-level covariates.
Among 242,514 pregnancies, 366,241 emergency department visits were identified. Moderate inequality was observed across socioeconomic groups (concentration index = - 0.17, 95% confidence interval - 0.18 to - 0.16). Rates of emergency department visits were 1.7 times higher among the most deprived groups compared to the least deprived groups (adjusted rate ratio = 1.7; 95% confidence interval 1.6 to 1.8). Inequality across the rural-urban continuum was more pronounced (concentration index of - 0.31 (95% confidence interval - 0.32 to - 0.30), with rural residents experiencing significantly higher emergency department use. Compared to metropolitan areas, emergency department visits were nearly three times higher in rural centers (adjusted rate ratio = 2.9; 95% confidence interval 2.8 to 3.0) and near six times higher in rural remote areas (adjusted rate ratio = 5.5; 95% confidence interval 5.3 to 5.7).
Significant inequalities in perinatal emergency department utilization are evident across both socioeconomic and urban-rural gradients. These findings highlight the need for targeted health-system interventions to improve access to appropriate, continuous perinatal care among disadvantaged and rural populations.
评估加拿大艾伯塔省围产期期间，社会经济和城乡梯度方面在急诊科就诊情况的不平等现象。
我们对2011年至2017年艾伯塔省基于人群的活产妊娠队列研究进行了二次分析。分析了孕期及产后1年内的急诊科就诊情况。社会经济地位采用从物质和社会剥夺五分位数得出的25个组合组进行评估。根据艾伯塔省卫生服务局的分类，城乡居住地分为七个地理组。集中指数量化了急诊科就诊情况的不平等现象，分为低（≤0.05）、中（0.06 - 0.19）或高（≥0.20）。多级负二项回归模型估计调整后的率比和95%置信区间，以衡量社会经济和城乡组之间急诊科就诊率的差异，并考虑个体层面的协变量。
在242,514例妊娠中，共识别出366,241次急诊科就诊。社会经济组之间观察到中度不平等（集中指数 = -0.17，95%置信区间 -0.18至 -0.16）。最贫困组的急诊科就诊率比最不贫困组高1.7倍（调整后的率比 = 1.7；95%置信区间1.6至1.8）。城乡连续体之间的不平等更为明显（集中指数为 -0.31（95%置信区间 -0.32至 -0.30），农村居民的急诊科使用率显著更高。与大都市区相比，农村中心的急诊科就诊率几乎高三倍（调整后的率比 = 2.9；95%置信区间2.8至3.0），农村偏远地区则高近六倍（调整后的率比 = 5.5；95%置信区间5.3至5.7）。
围产期急诊科就诊情况在社会经济和城乡梯度方面均存在显著不平等。这些发现凸显了有针对性的卫生系统干预措施的必要性，以改善弱势群体和农村人口获得适当、持续围产期护理的机会。
