Sociodemographic characteristics and emergency department visits and inpatient hospitalizations for atopic dermatitis in Ontario: a cross-sectional study

Abstract

Background: Some jurisdictions experience sociodemographic disparities in atopic dermatitis care, including emergency department visits, but data from Canada are limited. Our objectives were to estimate the prevalence of atopic dermatitis in Ontario and to identify sociodemographic factors associated with emergency department visits and hospitalizations for this condition.

Methods: We conducted a cross-sectional analysis of patients in the Electronic Medical Record Primary Care database linked with administrative health data for Ontario, Canada. We estimated period prevalence and health service utilization for atopic dermatitis from 2005 to 2015. We used multivariable log-binomial regression to calculate adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for associations between local dermatologist density and the proportion of emergency department visits and hospitalizations for atopic dermatitis.

Results: Among 249 984 patients, we identified 7812 with atopic dermatitis (period prevalence 2005-2015: 3.1%). Almost all physician visits for atopic dermatitis were to primary care physicians (> 99%). For every additional dermatologist per 100 000 population, the proportions of emergency department visits and hospitalizations for atopic dermatitis increased by 29% (RR 1.29, 95% CI 1.05-1.57). This relationship occurred in and around Toronto but was not consistent across the province.

Interpretation: In Ontario, higher dermatologist density was not associated with lower emergency department utilization and hospitalization for atopic dermatitis; the association varied in different locales with similar dermatologist densities. Strategies to improve access to care for atopic dermatitis should be tailored to local contexts.

Figure 1:

Association between dermatologist density and health service utilization for atopic dermatitis. Results are presented for multivariable log-binomial regression models to calculate risk ratios and 95% confidence intervals for associations between dermatologist density and the proportions of health care visits for atopic dermatitis: emergency department visits and hospitalizations; all physician visits; primary care visits; specialist visits (including dermatologist visits); and dermatologist visits. We studied each outcome in a separate multivariable model that also included age (continuous), sex, continuity of primary care (in 2014/15; not rostered, low, high), whether the patient had seen a dermatologist for atopic dermatitis, rurality of residency, ACG comorbidity score (low [0–4], moderate [5–9], high [≥ 10]), ACG morbidity score (nonuser or healthy user, or low, moderate, high morbidity), neighbourhood income, dependency, deprivation, ethnic concentration and residency instability quintiles. For each outcome, we also included the patient’s mean annual volume of that specific encounter type. Note: ACG = Johns Hopkins Adjusted Clinical Group, CI = confidence interval, ED = emergency department, RR = risk ratio.

Figure 2:

Proportions of health care visits associated with atopic dermatitis and dermatologist density by Ontario Local Health Integration Network: (A) emergency department visits and hospitalizations; (B) all physician visits; (C) primary care visits; (D) specialist visits (including dermatologist visits); and (E) dermatologist visits. Dermatologist density (per 100 000 population) is plotted using blue bars against the left y-axes; health service utilization for atopic dermatitis is plotted with green lines against the right y-axes. Local Health Integration Network numbers (x-axes): 1 = Erie St. Clair; 2 = South West; 3 = Waterloo Wellington; 4 = Hamilton Niagara Haldimand Brant; 5 = Central West; 6 = Mississauga Halton; 7 = Toronto Central; 8 = Central; 9 = Central East; 10 = South East; 11 = Champlain; 12 = North Simcoe Muskoka; 13 = North East; 14 = North West. Note: ED = emergency department.