Socioeconomic and rural-urban inequalities in emergency department utilization during the perinatal period

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.