Presented at the Canadian Association of Emergency Physicians annual conference, Victoria, British Columbia, Canada, June 2007.
A Population-based Study of the Association Between Socioeconomic Status and Emergency Department Utilization in Ontario, Canada
Version of Record online: 15 AUG 2011
© 2011 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 18, Issue 8, pages 836–843, August 2011
How to Cite
Khan, Y., Glazier, R. H., Moineddin, R. and Schull, M. J. (2011), A Population-based Study of the Association Between Socioeconomic Status and Emergency Department Utilization in Ontario, Canada. Academic Emergency Medicine, 18: 836–843. doi: 10.1111/j.1553-2712.2011.01127.x
The authors have no disclosures or conflicts of interest to report.
Supervising Editor: Lowell Gerson, PhD.
- Issue online: 15 AUG 2011
- Version of Record online: 15 AUG 2011
- Received December 8, 2010; revisions received February 3 and February 7, 2011; accepted February 7, 2011.
ACADEMIC EMERGENCY MEDICINE 2011; 18:836–843 © 2011 by the Society for Academic Emergency Medicine
Objectives: The relative effects of socioeconomic status (SES) and health status on emergency department (ED) utilization are controversial. The authors examined this in a setting with universal health coverage.
Methods: For Ontario participants age 20–74 years, Canadian Community Health Survey 2000 to 2001 responses were linked to Ontario Health Insurance Plan (OHIP) physician utilization data for 1999 to 2001 and the National Ambulatory Care Reporting System (NACRS) for ED utilization in 2002. SES was defined primarily according to high school completion and secondarily according to income. The primary outcome was less urgent ED visit, defined as Canadian Triage and Acuity Scale (CTAS) 4 or 5 and not admitted to hospital.
Results: The weighted sample was 9,323,217. Overall, 31.4% of the sample used an Ontario ED in 2002. The majority of visits (59.1%) were classified as less urgent. Fair or poor self-perceived health was the largest predictor of ED use, regardless of visit urgency. Respondents with low education were more likely to have both less urgent visits (odds ratio [OR] = 1.65, 95% confidence interval [CI] = 1.35 to 1.94) and more urgent visits (OR = 1.39, 95% CI = 1.09 to 1.68) after controlling for age, sex, income, self-perceived health, urban or rural location, regular doctor, and non-ED physician visits. Education was not associated with having less urgent versus more urgent visits (OR = 0.92, 95% CI = 0.68 to 1.14).
Conclusions: In a setting with universal health insurance, worse health status is the largest predictor of ED utilization, but low SES is independently associated with increased use of the ED, regardless of visit urgency. This study lends support to findings in other health systems that those using EDs are more ill and more disadvantaged.