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Socioeconomic status of emergency department users in Ontario, 2003 to 2009

Published online by Cambridge University Press:  04 March 2015

April P. Tozer ,
Paul Belanger ,
Kieran Moore  and
Jaelyn Caudle
April P. Tozer*
Affiliation:
Department of Emergency Medicine, Queen's University, Kingston, ON
Paul Belanger
Affiliation:
Geography, Queen's University, Kingston, ON Kingston, Frontenac, Lennox & Addington Public Health, Kingston, ON
Kieran Moore
Affiliation:
Kingston, Frontenac, Lennox & Addington Public Health, Kingston, ON
Jaelyn Caudle
Affiliation:
Department of Emergency Medicine, Queen's University, Kingston, ON
*
Department of Emergency Medicine, Kingston General Hospital, Empire 3, 76 Stuart Street, Kingston, ON K7L 2V7; [email protected]

Abstract

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Objective:

Emergency department (ED) overcrowding in Canada is an ongoing problem resulting in prolonged wait times, service declines, increased patient suffering, and adverse patient outcomes. We explored the relationship between socioeconomic status (SES) and ED use in Canada's universal health care system to improve our understanding of the nature of ED users to both improve health care to the most deprived populations and reduce ED patient input.

Methods:

This retrospective study took information from the National Ambulatory Care Reporting System (NACRS) database for all ED visits in Ontario between April 1, 2003, and March 31, 2010. As there is no direct measure of SES available from ED visit records, a proxy measure of SES was used, namely a deprivation index (DI) developed from material and social factors from the 2006 Canadian census using the patient's residential neighbourhood. DI scores were assigned to ED visit records using Statistics Canada's Postal Code Conversion File, which links postal and census geography.

Results:

A total of 36,765,189 visits occurred during the study period. A cross-province trend was found wherein the most deprived population used EDs disproportionately more than the least deprived population (relative risk: 1.971 95% confidence interval 1.969–1.973, p < 0.0001). This trend was stable across the entire study period, although the divergence is attenuating.

Conclusion:

Social determinants of health clearly impact ED use patterns. People of the lowest SES use ED services disproportionately more than other socioeconomic groups. Focused health system planning and policy development directed at optimizing health services for the lowest SES populations are essential to changing ED use patterns and may be one method of decreasing ED overcrowding.

Keywords

emergency department crowdingemergency department useemergency department wait timessocial determinants of healthsocioeconomic status
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 3 , May 2014 , pp. 220 - 225
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1. Canadian Agency for Drugs and Technologies in Health. CADTH assessment series on Canadian ED overcrowding – 2006. Emergency department overcrowding in Canada: what are the issues and what can be done? Overview. Available at: (accessed August 20, 2012).Google Scholar
2. Caandain Association of Emergency Physicians. Position statement on emergency department overcrowding from the Canadian Association of Emergency Physicians, 2009. Available at: (accessed August 20, 2012).Google Scholar
3. Tripartite Committee (OMA, OHA, MOHLTC) – 2006. Improving access to emergency care: addressing system issues. Available at: (accessed August 20, 2012).Google Scholar
4. Ministry of Health and Long-Term Care. Ontario wait times, emergency room wait times. 2008. Available at: (accessed August 20, 2012).Google Scholar
5. Ministry of Health and Long-Term Care. Ontario’s Pay-for-Results Program. 2010. Available at: (accessed August 20, 2012).Google Scholar
6. Canadian Agency for Drugs and Technologies in Health. CADTH assessment series on Canadian ED overcrowding – 2006. Emergency department overcrowding in Canada: what are the issues and what can be done? Report #4: Interventions to reduce overcrowding in emergency departments. Available at: (accessed August 20, 2012).Google Scholar
7. Ministry of Health and Long-Term Care, Ontario wait times, Ontario’s emergency room wait time strategy. Available at: (accessed August 20, 2012).Google Scholar
8. Flores-Mateo, G, Violan-Fors, C, Carrillo-Santisteve, P, et al. Effectiveness of organizational interventions to reduce emergency department utilization: a systematic review. PLoS One 2012;7:e35903, doi:10.1371/journal.pone.0035903.Google Scholar
9. Canadian Institute for Health Information. Reducing gaps in health: a focus on socio-economic status in urban Canada. 2008. Available at: (accessed August 20, 2012).Google Scholar
10. Stern, RS, Weissman, JS, Epstein, AM. The emergency department as a pathway to admission for poor and high-cost patients. JAMA 1991;266:2238–43, doi:10.1001/jama.1991.03470160070034.Google Scholar
11. Alter, DA, Stukel, T, Chong, A, et al. Lesson from Canada’s universal care: socially disadvantaged patients use more health services, still have poorer health. Health Aff 2011;30:2274–83, doi:10.1377/hlthaff.2009.0669.Google Scholar
12. Lowthian, JA, Curtis, AJ, Cameron, PA, et al. Systematic review of trends in emergency department attendances: an Australian perspective. Emerg Med J 2011;28:373–7, doi:10.1136/emj.2010.099226.Google Scholar
13. Khan, Y, Glazier, RH, Moineddin, R, et al. A populationbased study of the association between socioeconomic status and emergency department utilization in Ontario, Canada. Acad Emerg Med 2011;18:836–43, doi:10.1111/j.1553-2712.2011.01127.x.Google Scholar
14. Pampalon, R, Guy, R. A deprivation index for health and welfare planning in Quebec. Chronic Dis Inj Can 2000;21:104–13.Google Scholar
15. Pampalon, R, Hamel, D, Gamache, P. A comparison of individual and area-based socio-economic data for monitoring social inequalites in health. Health Rep 2009;20:85–94.Google Scholar
16. Pampalon, R, Hamel, D, Gamache, P, et al. A deprivation index for health planning in Canada. Chronic Dis Can 2009;29:178–91.Google Scholar
17. Statistics Canada. Dissemination area. Available at: (accessed August 20, 2012).Google Scholar
18. The R Project for Statistical Computing. Available at: (accessed August 20, 2012).Google Scholar
19. Ontario’s emergency room wait time strategy. Available at: (accessed August 20, 2012).Google Scholar
20. Zuckerman, S, Shen, YC. Characteristics of occasional and frequent emergency department users: do insurance coverage and access to care matter? Med Care 2004;42:176–82, doi:10.1097/01.mlr.0000108747.51198.41.Google Scholar
21. Weber, EJ, Showstack, JA, Hunt, KA, et al. Does lack of a usual source of care or health insurance increase the likelihood of an emergency department visit? Results of a national population-based study. Ann Emerg Med 2005;45:4–12, doi:10.1016/j.annemergmed.2004.06.023.Google Scholar
22. Hunt, KA, Weber, EJ, Showstack, JA, et al. Characteristics of frequent users of emergency departments. Ann Emerg Med 2006;48:1–8, doi:10.1016/j.annemergmed.2005.12.030.Google Scholar
23. Miller, JB, Brauer, E, Rao, H, et al. The most frequent ED patients carry insurance and a significant burden of disease. Am J Emerg Med 2012 July 16. [Epub ahead of print]Google Scholar
24. Weber, EJ, Showstack, JA, Hunt, KA, et al. Are the uninsured responsible for the increase in emergency department visits in the United States? Ann Emerg Med 2008;52:108–15, doi:10.1016/j.annemergmed.2008.01.327.Google Scholar
25. Ginde, AA, Lowe, RA, Wiler, JL. Health insurance status change and emergency department use among US adults. Arch Intern Med 2012;172:642–7, doi:10.1001/archinternmed.2012.34.Google Scholar