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- Title
Comparison of Emergency Department Use Between Pregnant People With and Without Disabilities in Ontario, Canada.
- Authors
Brown, Hilary K.; Varner, Catherine; Ray, Joel G.; Scime, Natalie V.; Fung, Kinwah; Guttmann, Astrid; Havercamp, Susan M.; Vigod, Simone N.; Lunsky, Yona
- Abstract
This cohort study compares emergency department use between pregnant people with and without disabilities in Ontario, Canada. Key Points: Question: Are individuals with disabilities at greater risk of emergency department use in pregnancy compared with those without disabilities? Findings: In a cohort study of more than 2 million pregnant people in Ontario, Canada, the adjusted relative risk of emergency department use was 26% higher in those with physical, 15% higher in those with sensory, 33% higher in those with intellectual or developmental, and 43% higher in those with multiple disabilities, compared with people without disabilities. Meaning: These findings suggest the need for research on the benefits of strategies to manage preexisting conditions and improve access to outpatient care for disabled individuals in pregnancy. Importance: Emergency department (ED) use in pregnancy is common and occurs for a variety of reasons, including obstetrical complications, exacerbated underlying conditions, and inadequate outpatient health care access. People with disabilities have elevated rates of certain medical, psychiatric, and obstetrical conditions as well as inadequate access to prenatal care; their risk of ED use in pregnancy is not known, however. Objective: To compare the risk of ED use in pregnancy among people with physical, sensory, and intellectual or developmental disabilities with those without disabilities. Design, Setting, and Participants: Population-based cohort study leveraging linked administrative health data sets in Ontario, Canada, April 2003 to March 2019. Analysis included all recognized pregnancies to people with a preexisting physical, sensory, intellectual or developmental, or 2 or more (multiple) disabilities, and those without a disability. Data were analyzed from May 2022 to January 2023. Exposure: Disability was ascertained using algorithms applied to 2 or more outpatient physician visits or 1 or more ED visits or hospitalizations before conception. Main outcomes and measures: Modified Poisson regression–generated adjusted relative risks (aRR) and 95% CIs for any ED visit in pregnancy, from the estimated conception date up to the end of the pregnancy, adjusted for age, parity, income quintile, rurality, immigrant status, and preexisting chronic conditions, mental illness, and substance use disorders. Results: The cohort included 2 659 895 pregnant people with physical (221 739 participants; mean [SD] age, 29.8 [6.1] years), sensory (71 891 participants; mean [SD] age, 29.1 [6.4] years), intellectual or developmental (3877 participants; mean [SD] age, 26.1 [6.7] years), and multiple disabilities (14 359 participants; mean [SD] age, 29.5 [6.5] years), and pregnant people without a disability (2 348 023 participants; mean [SD] age, 29.4 [5.9] years). The rate of ED visits in pregnancy was 25.4% in people without a disability (596 771 visits). Relative to these individuals, the aRR for ED use was elevated in people with physical (aRR, 1.26; 95% CI, 1.25-1.27), sensory (aRR, 1.15; 95% CI, 1.14-1.17), intellectual or developmental (aRR, 1.33; 95% CI, 1.28-1.38), and multiple disabilities (aRR, 1.43; 95% CI, 1.40-1.46). Conclusions and Relevance: In this population-based study, people with disabilities were at elevated risk of ED use in pregnancy. This finding underscores the need for research on the benefits of proactive strategies to manage preexisting conditions in these individuals, improve their access to outpatient obstetrical and medical care, and prepare them for when ED visits occur.
- Subjects
ONTARIO; RELATIVE medical risk; HOSPITAL emergency services; CONFIDENCE intervals; DEVELOPMENTAL disabilities; COMPARATIVE studies; RESEARCH funding; DESCRIPTIVE statistics; PEOPLE with disabilities; INTELLECTUAL disabilities; LONGITUDINAL method; POISSON distribution; PREGNANCY
- Publication
JAMA Network Open, 2023, Vol 6, Issue 8, pe2327185
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.27185