Beyond Wait Times: Neighborhood Income Distribution Among Emergency Department Visits Assigned a...

Objectives Patients who leave emergency departments (EDs) without being seen may experience adverse outcomes and are recognized as a marker of strain in the health care system. This study described the characteristics of ED visits assigned a leave-without-being-seen (LWBS) disposition at a tertiary care ED and evaluated how demographic and visit-level characteristics varied across neighborhood income categories. Methodology This retrospective descriptive study included all ED visits assigned an LWBS disposition at Saint John Regional Hospital from January 1 to December 31, 2025. Socioeconomic status was assigned using Statistics Canada Postal Code Conversion File Plus (PCCF+) Version 8D and neighborhood income quintiles (QABTIPPE). Descriptive statistics were used to summarize patient characteristics. Categorical variables were compared using chi-square tests, and continuous variables were compared using Kruskal-Wallis tests. Results A total of 7,221 ED visits were assigned an LWBS disposition. Socioeconomic linkage was successful in 6,824 visits (94.5%). The median age was 36 years (interquartile range (IQR) 21-58), and 3,925 (54.4%) visits were listed as female in the administrative dataset. Among visits assigned an LWBS disposition with successful socioeconomic linkage, the number of visits was highest in the lowest neighborhood income category (2,225, 32.9%) and lowest in the highest neighborhood income category (846, 12.5%). Documented primary care provider (PCP) status varied significantly across neighborhood income categories. Visits from lower-income neighborhoods were more frequently missing a documented PCP in the administrative dataset than visits from higher-income neighborhoods (724, 32.8% vs. 125, 14.9%; χ²(4) = 158.6, P < 0.001). Median wait times to LWBS were similar across income categories, with no statistically significant difference (Kruskal-Wallis χ²(4) = 4.00, P = 0.406). Conclusions Among visits assigned an LWBS disposition, a larger number of visits originated from lower-income neighborhoods, and absence of a documented PCP was more frequent in lower-income categories. Median wait times were similar across neighborhood income categories. These findings describe socioeconomic patterns within the LWBS population and should not be interpreted as identifying factors that contribute to LWBS. Future studies incorporating comparator groups are needed to better characterize socioeconomic differences in LWBS visits.