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Objective <p>To assess inequalities in emergency department utilization during the perinatal period across socioeconomic and rural–urban gradients in Alberta, Canada. </p> Methods <p>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.</p> Results <p>Among 242,514 pregnancies, 366,241 emergency department visits were identified. Moderate inequality was observed across socioeconomic groups (concentration index = −&#xa0;0.17, 95% confidence interval −&#xa0;0.18 to −&#xa0;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 −&#xa0;0.31 (95% confidence interval −&#xa0;0.32 to −&#xa0;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).</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 发表日期：

    2025年6月4日

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  • Ruben Ohanian,
  • Jesus Serrano-Lomelin,
  • Brian H. Rowe,
  • Susan Crawford,
  • Susan Jelinski,
  • Maria B. Ospina

摘要

Objective

To assess inequalities in emergency department utilization during the perinatal period across socioeconomic and rural–urban gradients in Alberta, Canada.

Methods

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.

Results

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).

Conclusion

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.