Examining the impact of the first wave of COVID-19 on equitable access to emergency care across Alberta demographic groups: a retrospective observational study
Bibliographic record
Abstract
BACKGROUND: During the first wave of the COVID-19 pandemic, there was a notable decline in emergency department (ED) usage in many jurisdictions. This study assessed changes in ED use during this period and explored how the pandemic may have aggravated existing healthcare access inequities. OBJECTIVES: Our primary objective was to assess pandemic-related changes to ED visits and emergency hospitalisations for distinct demographic groups. DESIGN: We conducted a retrospective observational study using population-based provincial administrative data. SETTING: We analysed data from all the 109 EDs and urgent care centres in Alberta, Canada, during the first wave of the COVID-19 pandemic (15 March 2020 to 30 June 2020), and during the corresponding (control) period 1 year earlier. We conducted subgroup analyses by age, First Nations status, sex, location and material deprivation. We repeated all analyses for pre-selected life-threatening emergency diagnoses. POPULATIONS: We examined outcomes for a priori subgroups, including female and 'other' sex patients, paediatric patients (age 0-17 years), seniors (age 65 years and older), patients living in remote areas (greater than 200 km from an urban centre), First Nations members and patients living in materially deprived postal codes falling into the two most deprived Pampalon Index quintiles. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were number of ED visits, number of ED visits with admission to hospital and number of ED visits resulting in patient death in the ED. A secondary outcome was change in ED use for life-threatening diagnoses (eg, cardiac conditions and hepatic disease). RESULTS: ED visits in the COVID-19 period decreased by 34% (Poisson means test p <0.001) and hospitalisations decreased by 15% (p <0.001) compared with 2019. Multivariable models showed an average decrease of 79.9 (p <0.001) ED visits, and 7.7 (p <0.001) fewer average admissions per facility for the COVID-19 period (vs 2019) in our 'baseline' group (non-First Nations, male, adult and metropolitan residents who were not materially deprived). First Nations patients, seniors and remote residents experienced smaller declines in ED visits compared with the baseline group. Females, seniors and children experienced larger reductions in emergency admissions, while First Nations patients had smaller reductions. CONCLUSION: Reductions in critical emergency care and emergency hospital admissions were unequally distributed across demographic groups during the COVID-19 period. Study methods could be used to monitor and support equitable access to emergency care among distinct populations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".