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Effects of rurality and geographical distance on unplanned emergency department utilization for children with asthma: a population level retrospective cohort study


Background — Asthma is a highly prevalent chronic disease among Ontario children; however, the extent to which rural status and distance are associated with unplanned emergency department (ED) use by this population is largely unknown.

Objective — To explore the impact of rurality and geographical distance to primary and specialist care services on healthcare utilization by analyzing the use of unplanned ED services.

Methods — A population level retrospective cohort study of Ontario children ages 5-14 with newly diagnosed asthma was conducted using health administrative data from Institute for Clinical Evaluative Sciences (ICES). Adjusted logistic regression models were used to analyze the association between unplanned ED use with rural status and distance to general practitioner/family physician (GP/FP) and specialist healthcare services, while controlling for confounders.

Results — In total, 19,732 individuals met the inclusion criteria. Individuals who lived in rural locations (OR 2.00, 95% CI 1.64-2.44) and travelled >50 km to a GP/FP (OR 1.25, 95% CI 1.06-1.48) or specialist (OR 1.20, 95% CI 1.05-1.38) were more likely to utilize an ED.

Conclusion — Children with asthma utilize healthcare services differently based on rural status and distance to services. To ensure equitable access to care, there is a need to accommodate for these factors in the planning and provision of asthma healthcare services.



Wilson J, Gedcke-Kerr L, Woo K, Plazas PC, Tranmer J. Can J Nurs Res. 2020; 53(4):397-404. Epub 2020 Dec 6.

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