Spatial Inequalities of Maternal Emergency Department Visits During Pregnancy and Postpartum in the Two Largest Urban Centres in Alberta: A Tale of Two Citites
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Authors
Brandwood, Alec Janes
Date
2024-08-19
Type
thesis
Language
eng
Keyword
Maternal Health , Pregnancy , Postpartum , Emergency Department Utilization , Cross-sectional , Spatial analysis
Alternative Title
Abstract
Introduction: The perinatal period is extremely sensitive with immediate and long-term consequences for both the mother and child. In Alberta, inequalities exist in maternal utilization of emergency department (ED) services across socioeconomic groups and several demographic and clinical characteristics. However, the geographic distribution of these inequalities has not been fully explored. The aim of this study was to identify geographic inequalities in maternal ED utilization during pregnancy and postpartum in Calgary and Edmonton, two major urban centres in Western Canada.
Methods: We conducted a cross-sectional geographic analysis of data from a retrospective cohort of all pregnancies leading to live births that occurred between 2011 and 2017 within the city limits of Calgary and Edmonton. Dissemination areas were used as the geographic unit to aggregate all ED visits. Spatial filters were used to generate spatial groups for the identification of geographic inequalities in the prevalence of maternal ED utilization, through a Concentration Index approach, in both Calgary and Edmonton. The percentage of individual and ED-visit characteristics were compared across the area groups delineated by the spatial filters.
Results: The average gap between areas with the highest and the lowest prevalence of maternal ED utilization was 1.8-fold in Calgary and 2.3-fold in Edmonton. During the postpartum period, the difference was 2.18-fold for Calgary and 2.70-fold for Edmonton. Results from the concentration index showed moderate inequality in Calgary (-0.14 for pregnancy; - 0.14 for postpartum) and Edmonton (-0.17 for pregnancy; -0.20 for postpartum). Areas of higher ED utilization were associated with a higher percentage of women under 25 years at birth, comorbid mental health conditions, inadequate prenatal care, and a lower percentage of obstetric-related ED visits. In Edmonton, the percentage of pregnancies with major or minor comorbidities were greater in areas of higher ED utilization.
Conclusion: Geographic inequalities in maternal ED utilization were not completely explained by the spatial distribution of socioeconomic status. Geographic patterns of inequality during the pregnancy and postpartum period were identified. Age, comorbidities including both mental health and major or moderate chronic conditions, inadequate prenatal care, and lower prevalence of obstetric-related visits were associated with areas of higher ED utilization.
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Queen's University's Thesis/Dissertation Non-Exclusive License for Deposit to QSpace and Library and Archives Canada
ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Queen's University's Thesis/Dissertation Non-Exclusive License for Deposit to QSpace and Library and Archives Canada
ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.