Disparities in use of a virtual pediatric emergency department in Ottawa, Canada

Virtual care can facilitate access to pediatric emergency departments (EDs), but it is unclear if virtual care is equitably accessed by patients from marginalized communities. This study compares the use of a virtual pediatric ED between neighbourhoods with different levels of marginalization.

This is a cross-sectional study of virtual ED visits per neighbourhood (defined by census dissemination area) within 100 km of a tertiary-care pediatric hospital in Ottawa, Ontario, from May to December 2020. Our primary outcome was incidence rate ratios (IRRs) of virtual ED visits for each quintile of the Ontario Marginalization Index's four dimensions: material deprivation, ethnic concentration, residential instability, and dependency. We conducted a negative binomial regression and adjusted for distance from the hospital.

There were 2920 virtual ED visits from 1076 dissemination areas. Compared to the first quintile of material deprivation (wealthier neighbourhoods), there were lower adjusted IRRs of virtual pediatric ED visits for the third (0.80, 95% confidence interval [CI] 0.68 to 0.94), fourth (0.79, 95% CI 0.67 to 0.94), and fifth (0.51, 95% CI 0.42 to 0.61) quintiles. The highest quintile of ethnic concentration (more diverse neighbourhoods) had a lower adjusted IRR compared to the lowest quintile (0.79, 95% CI 0.82 to 0.87). The adjusted IRR for the second quintile of residential instability was slightly higher than the first quintile (1.20; 95% CI 1.02 to 1.41). Adjusted IRR of visits did not vary by dependency.

Wealthier and less ethnically diverse neighbourhoods displayed higher rates of virtual pediatric ED visits, after adjusting for distance to the hospital.