Examining the impact of the first wave of COVID-19 on equitable access to emergency care across Alberta demographic groups: a retrospective observational study

Background During the first wave of the COVID-19 pandemic, there was a notable decline in emergency department (ED) usage in many jurisdictions. This study assessed changes in ED use during this period and explored how the pandemic may have aggravated existing healthcare access inequities.Objectives Our primary objective was to assess pandemic-related changes to ED visits and emergency hospitalisations for distinct demographic groups.Design We conducted a retrospective observational study using population-based provincial administrative data.Setting We analysed data from all the 109 EDs and urgent care centres in Alberta, Canada, during the first wave of the COVID-19 pandemic (15 March 2020 to 30 June 2020), and during the corresponding (control) period 1 year earlier. We conducted subgroup analyses by age, First Nations status, sex, location and material deprivation. We repeated all analyses for pre-selected life-threatening emergency diagnoses.Populations We examined outcomes for a priori subgroups, including female and ‘other’ sex patients, paediatric patients (age 0–17 years), seniors (age 65 years and older), patients living in remote areas (greater than 200 km from an urban centre), First Nations members and patients living in materially deprived postal codes falling into the two most deprived Pampalon Index quintiles.Primary and secondary outcome measures Primary outcomes were number of ED visits, number of ED visits with admission to hospital and number of ED visits resulting in patient death in the ED. A secondary outcome was change in ED use for life-threatening diagnoses (eg, cardiac conditions and hepatic disease).Results ED visits in the COVID-19 period decreased by 34% (Poisson means test p <0.001) and hospitalisations decreased by 15% (p <0.001) compared with 2019. Multivariable models showed an average decrease of 79.9 (p <0.001) ED visits, and 7.7 (p <0.001) fewer average admissions per facility for the COVID-19 period (vs 2019) in our ‘baseline’ group (non-First Nations, male, adult and metropolitan residents who were not materially deprived). First Nations patients, seniors and remote residents experienced smaller declines in ED visits compared with the baseline group. Females, seniors and children experienced larger reductions in emergency admissions, while First Nations patients had smaller reductions.Conclusion Reductions in critical emergency care and emergency hospital admissions were unequally distributed across demographic groups during the COVID-19 period. Study methods could be used to monitor and support equitable access to emergency care among distinct populations.