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Hot spots for pediatric asthma emergency department visits in Ottawa, Canada
Falana Sheriff1,2, Amisha Agarwal3, Madhura Thipse3
1Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Insights
Pediatric asthma emergency department visits are concentrated in specific urban areas. These "hot spots" show overlap with marginalized communities, particularly those with high ethnic concentration, suggesting targeted prevention strategies are needed.
Area of Science:
- Public Health
- Pediatric Medicine
- Health Services Research
Background:
- Pediatric asthma emergency department (ED) visits represent a significant healthcare burden.
- Geographic variations in asthma ED visits are linked to marginalization, but require granular analysis for targeted interventions.
Purpose of the Study:
- To map city-level geographic variations in pediatric asthma ED visit and re-visit rates.
- To examine the relationship between these rates and marginalization at a granular level.
Main Methods:
- Retrospective cohort study of children (ages 1-17) with asthma ED visits at Children's Hospital of Eastern Ontario (CHEO).
- Linked patient postal codes to census tracts to map ED visit/re-visit rates.
- Assessed overlap with the Ontario Marginalization Index.
Main Results:
- 18.5% of children had a repeat ED visit within one year.
- Identified 10 "hot spot" census tracts for both asthma ED visits and re-visits.
- Observed overlap between urban hot spots and areas with high ethnic concentration or low dependency.
Conclusions:
- Pediatric asthma ED visit and re-visit rates are geographically heterogeneous at the city level.
- Urban hot spots exhibit greater overlap with marginalization indicators compared to rural areas.
- Findings support developing geographically-targeted community strategies for asthma prevention in vulnerable populations.
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.
Abstract:
Supplemental data for this article can be accessed at publisher's website.
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