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

Abstract

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. RÉ SUMÉObjectif: L'encombrement des services des urgences (SU) au Canada est un problè me chronique, qui a pour effets de prolonger les dé lais d'attente, de diminuer la qualité des services, d'accroître les souffrances des patients et d'alté rer l'é volution de leur é tat de santé . Nous avons donc examiné la relation entre le statut socioé conomique (SSE) des usagers et l'utilisation des SU dans le cadre du systè me de soins de santé universels au Canada afin de dé gager les caracté ristiques de ces usagers, et ce, dans l'optique d'amé liorer la qualité des soins donné s aux populations les plus dé favorisé es et de diminuer le nombre de patients dans les SU. Ré sultats: Au total, 36 765 189 consultations ont é té dé nombré es durant la pé riode à l'é tude. Une tendance gé né rale s'est dé gagé e de tous les SU de la province: les populations les plus dé favorisé es ont eu recours aux SU de maniè re disproportionné e par rapport aux populations les moins dé favorisé es (risque relatif: 1.971; intervalle de confiance à 95%: 1.969-1.973; p , 0.0001). La tendance s'est ré vé lé e stable tout le long de la pé riode à l'é tude, bien que l'é cart soit en voie de diminution maintenant. Conclusions: Les dé terminants sociaux de la santé ...

Return to system within 30 days of discharge following pediatric shunt surgery

“…Education and income have been shown to correlate strongly with ED usage, regardless of the actual cost or availability of emergency services within the region. 15,17 These variables represent socioeconomic modifiers that future efforts to reduce rebound to the ED in patients treated with shunts will have to consider, and they have already been identified as relevant for other disease entities as well. 11,12 In certain institutions, patient literacy programs and early postoperative appointments have been implemented, with some success, to bridge the gap in education and social support suffered by these patients.…”

Looking Beyond Income and Education

“…[9][10][11][12] Efforts to address high-cost use have primarily been limited to case management of high-risk patients, such as the elderly and those with multi-morbidity. 12,13 Few studies, however, have highlighted the importance of the upstream determinants of high-cost use. 7,10,[13][14][15][16][17] Despite universal insurance coverage in Canada's healthcare system, Dunlop et al 11 observed a distinct relationship between SES and frequent users of primary care in the 1994 National Population Health Survey.…”

“…12,13 Few studies, however, have highlighted the importance of the upstream determinants of high-cost use. 7,10,[13][14][15][16][17] Despite universal insurance coverage in Canada's healthcare system, Dunlop et al 11 observed a distinct relationship between SES and frequent users of primary care in the 1994 National Population Health Survey. It is reasonable to expect that the SES-health gradient fundamental to so many inequities in health outcomes would extend to HCUs.…”

“…It is reasonable to expect that the SES-health gradient fundamental to so many inequities in health outcomes would extend to HCUs. 7,10,[13][14][15][16][17] To date, HCU research has been overwhelmingly cross-sectional and clinically focused, limited to the few sociodemographic characteristics available in administrative databases or relying on existing ecological measures. This approach has provided limited opportunities to study the drivers of high-cost use, especially those that may be intervened upon in the community before costs accrue.…”

Macroeconomic policies and increasing social-health inequality in Iran

“…The study suggested that the impact of macroeconomic policies on the health of people in the country must be constantly measured and before the implementation of new policies, positive or negative impacts of them must be investigated. Our results based on the experts' opinions showed that weak financial protection plans and inadequate coverage of insurances, a high level of out of pocket in health financing have negative impact on community health (55)(56)(57)(58). Macroeconomic policies such as the subsidies have great impact on the community health in the country and the effects should be measured.…”