The association between neighbourhood marginalization and SARS-CoV-2 outcomes in patients presenting to emergency departments

Ivy Cheng; Rhonda J Rosychuk; David Seonguk Yeom; Ray L Jewett; Iwona A Bielska; Jake Hayward; Jaspreet Khangura; Rohit Mohindra; Megan Landes; Jeffrey P Hau; Christiaan H Righolt; Murdoch Leeies; Jennifer Grant; Steven C Brooks; Corinne M Hohl; Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) Investigators

doi:10.17269/s41997-024-00976-5

The association between neighbourhood marginalization and SARS-CoV-2 outcomes in patients presenting to emergency departments

Can J Public Health. 2024 Dec 30. doi: 10.17269/s41997-024-00976-5. Online ahead of print.

Authors

Ivy Cheng^{1

2}, Rhonda J Rosychuk³, David Seonguk Yeom⁴, Ray L Jewett^{5

6}, Iwona A Bielska^{7

8}, Jake Hayward⁹, Jaspreet Khangura⁹, Rohit Mohindra^{10

11}, Megan Landes¹², Jeffrey P Hau⁴, Christiaan H Righolt¹³, Murdoch Leeies¹⁴, Jennifer Grant^{15

16}, Steven C Brooks¹⁷, Corinne M Hohl^{4

18}; Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) Investigators

Affiliations

¹ Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. [email protected].
² Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada. [email protected].
³ Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
⁴ Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
⁵ Department of Geography and Planning, University of Toronto, Toronto, ON, Canada.
⁶ Centre for Social Accountability, Northern Ontario School of Medicine University, Thunder Bay, ON, Canada.
⁷ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
⁸ Department of Health Policy and Management, Institute of Public Health, Jagiellonian University, Krakow, Poland.
⁹ Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada.
¹⁰ Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
¹¹ North York General Hospital, Toronto, ON, Canada.
¹² Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
¹³ Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹⁴ Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹⁵ Divisions of Medical Microbiology and Infectious Diseases, University of British Columbia, Vancouver, BC, Canada.
¹⁶ Division of Infectious Diseases and Medical Microbiology, Vancouver Coastal Health, Vancouver, BC, Canada.
¹⁷ Departments of Emergency Medicine and Public Health Sciences, Queen's University, Kingston, ON, Canada.
¹⁸ Emergency Department, Vancouver General Hospital, Vancouver, BC, Canada.

PMID: 39739247
DOI: 10.17269/s41997-024-00976-5

Abstract
in English, French

Objective: Social and economic marginalizations have been associated with inferior health outcomes in Canada. Our objective was to describe the relationship between neighbourhood marginalization and COVID-19 outcomes among patients presenting to Canadian emergency departments (ED).

Methods: We conducted an observational study among consecutive COVID-19 patients recruited from 47 hospitals participating in the Canadian COVID-19 ED Rapid Response Network (CCEDRRN) between March 3, 2020, and July 24, 2022. We linked data with the Canadian Marginalization Index (CAN-Marg). We used multivariable, multi-level logistic regression models to understand the association between dimensions of neighbourhood marginalization, and severe COVID-19 and in-hospital mortality.

Results: There were 55,588 eligible patients. Those from neighbourhoods with a higher proportion of recent immigrants (OR = 0.86 per unit increase [0.81, 0.92]), lower workforce participation (OR = 0.84 per unit increase [0.75, 0.94]), and more housing insecurity (OR = 0.81 per unit increase [0.77, 0.86]) were less likely to present to EDs with severe COVID-19. However, patients from materially marginalized neighbourhoods had increased odds of dying in hospital (OR = 1.19 per unit increase [95% CI 1.09, 1.30]) compared to patients from less materially marginalized neighbourhoods. Patients living in neighbourhoods with a higher proportion of recent immigrants (OR = 0.83 per unit increase [0.78, 0.91]) and lower participation in the workforce (OR = 0.77 per unit increase [0.66, 0.87]) experienced lower odds of dying.

Conclusion: Despite no association with severe COVID-19 at ED presentation, the only marginalization domain associated with in-hospital mortality was material deprivation. Our findings present insights on ED-seeking behaviour, hospital access, and care that population studies could not.

RéSUMé: OBJECTIF: La marginalisation sociale et économique est associée à de moins bons résultats cliniques au Canada. Nous avons voulu décrire la relation entre la marginalisation des quartiers et l’évolution de la COVID-19 chez les patients se présentant aux urgences au pays. MéTHODE: Nous avons mené une étude observationnelle de patients consécutifs avec COVID-19 recrutés dans 47 hôpitaux du CCEDRRN (Canadian COVID-19 Emergency Department Rapid Response Network) entre le 3 mars 2020 et le 24 juillet 2022. Nous avons lié les données à l’indice de marginalisation canadien (CAN-Marg). Nous avons ensuite utilisé des modèles de régression logistique multivariés à niveaux multiples pour comprendre l’association entre, d’une part, les dimensions de la marginalisation des quartiers et d’autre part, la COVID-19 sévère et la mortalité hospitalière. RéSULTATS: Il y avait 55 888 patients admissibles. Ceux venant de quartiers ayant une proportion élevée d’immigrants récents (RC = 0,86 par unité d’augmentation [0,81, 0,92]), une faible participation à la population active (RC = 0,84 par unité d’augmentation [0,75, 0,94]) et un indice de précarité du logement élevé (RC = 0,81 par unité d’augmentation [0,77, 0,86]) étaient moins susceptibles de se présenter aux urgences avec une COVID-19 sévère. Néanmoins, les patients venant de quartiers marginalisés sur le plan matériel étaient plus susceptibles de mourir à l’hôpital (RC = 1,19 par unité d’augmentation [IC de 95% 1,09, 1,30]) que les patients venant de quartiers moins marginalisés sur le plan matériel. Chez les patients venant des quartiers ayant une proportion élevée d’immigrants récents (RC = 0,83 par unité d’augmentation [0,78, 0,91]) et une faible participation à la population active (RC = 0,77 par unité d’augmentation [0,66, 0,87]), la probabilité de mourir était inférieure. CONCLUSION: Malgré l’absence d’association avec la COVID-19 sévère chez les patients se présentant aux urgences, le seul domaine de marginalisation associé à la mortalité hospitalière était la défavorisation matérielle. Nos constats jettent un éclairage que les études démographiques ne peuvent pas apporter sur les comportements de présentation aux urgences, l’accès à l’hôpital et les soins.

Keywords: COVID-19; Emergency department; Equity; Neighbourhood marginalization; Outcomes; SARS-CoV-2.

Abstract in English, French

Grants and funding

Abstract
in English, French