Abstract
Objective
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.
Methods
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.
Results
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.
Conclusion
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.
Acknowledgments
Thank you to Richard Webster for support with statistical analyses.
Declaration of interest
The authors have no financial or other competing interests to report.
Funding
There were no additional funding sources for the research reported in the manuscript.