Spatial Inequalities of Maternal Emergency Department Visits During Pregnancy and Postpartum in the Two Largest Urban Centres in Alberta: A Tale of Two Citites
Notice bibliographique
Résumé
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.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,005 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,002 | 0,000 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».