Spatial Inequalities of Maternal Emergency Department Visits During Pregnancy and Postpartum in the Two Largest Urban Centres in Alberta: A Tale of Two Citites
Bibliographic record
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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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.000 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.000 |
| 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".