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Attached Detailed Report PATIENT MARGINALIZATION AND COVID-19 EMERGENCY DEPARMENT (ED) VISITS DURING THE INITIAL WAVE OF THE PANDEMIC Prepared by: HHS Integrated Decision Support BI (IDS), September, 2020 Data Sources: 1. ED Visit & Marginalization Information: IDS: National Ambulatory Care Reporting System (NACRS), 2016 Ontario Marginalization Index 2. Population Counts: Statistics Canada, 2016 Census of Population, Statistics Canada Catalogue no. 98-400-X2016003. Accessed July, 2020. Purpose: To explore how the marginalization of a patient's community relates to the rate of adult COVID-19 ED visits (both suspected and confirmed cases) in the inital wave of the pandemic. Data Time Period: January to June, 2020 > For context, this is the time period outlined in red as displayed in the Public Health Ontario chart to the right, which shows confirmed daily cases in Ontario. IDS Patient Regions: Patients residing in the regions displayed below in blue are included in this report, accounting for about half the province of Ontario. For more details see Appendix A. Chart Source: Ontario Agency for Health Protection and Promotion (Public Health Ontario). Epidemiologic summary: COVID-19 in Ontario – January 15, 2020 to September 20, 2020. Toronto, ON: Queen’s Printer for © 2020 Mapbox © OpenStreetMap Ontario; 2020. https://files.ontario.ca/moh-covid-19-report-en-2020-09-21.pdf. Accessed on Sept 21, 2020. Rate of COVID-19 ED Visits Per 10,000 Adult Population, by Ontario Marginalization Dimensions Summary Table All IDS Patient Regions, Adults Only, Jan to Jun 2020 IDS Patient Regions Material Deprivation Residential Instability COVID-19 ED Visits 11,972 31.8 30 28.5 t t l l u 30 u Adult Population 5,392,245 d d 23.3 A A 23.4 n 23.2 n 20.6 0 0 o o 0 0 i i Rate Per 10,000 t t 20 0 0 17.7 17.6 , , a 17.7 a 22.2 l 20 l 0 17.0 0 u u 1 1 Adult Population p p r r o o e e P P P P e e 10 2016 ON MARG INDEX: t 10 t a a R R 1 - Least Marginalized to 5 - Most 0 0 Marginalized 1 2 3 4 5 1 2 3 4 5 Material Deprivation Dependency Ethnic Concentration Closely connected to poverty and refers to 25.7 40 35.2 the inability for individuals and t 24.6 t l l communities to access and attain basic u u d 20.9 d A A 30 material needs n n 0 20 18.2 18.2 0 o o 0 0 i i 22.7 t t 0 0 , , a a l l Residential Instability 0 0 18.3 u u 1 1 20 p p r r People who experience high rates of family o o e e 13.4 P P 12.3 P P 10 or housing instability e e t t 10 a a R R Dependency 0 0 People who do not have income from 1 2 3 4 5 1 2 3 4 5 employment (including seniors, children, and adults whose work is not Observations: Looking across all IDS patient regions, the rate of COVID-19 ED visits per population increases compensated) considerably as the material deprivation, residential instability or ethnic concentration of the patient's neighbourhood increases. In addition, the rate appears to decrease as dependency increases. Ethnic Concentration High area-level concentrations of people However, this aggregate level can be misleading. Results by public health unit on the next several pages, show who are recent immigrants and/or people that within each area the trend is less pronounced, especially for dependency and ethnic concentration. belonging to a ‘visible minority’ group (defined by Statistics Canada as “persons, Part of the reason for this, is that not all cities have an equal distribution of marginalization across the other than aboriginal peoples, who are non-Caucasian in race or non-white in dimensions. For example, Peel & Toronto contribute 77% of the population within the 'Ethnic Concentration 5' colour”). bar on this page, but only 3% of the population within the 'Ethnic Concentration 1' bar. Peel & Toronto regions have some of the highest rates of COVID-19 ED visits per population overall (regardless of Ethnic ON-MARG Definition Source: Matheson, FI; Ontario Agency for Health Protection and Promotion Concentration), and this higher overall rate has a large impact on the 'Ethnic Concentration 5' column and a low (Public Health Ontario). 2016 Ontario impact on the 'Ethnic Concentration 1' column. marginalization index: user guide. Toronto, ON: Providence St. Joseph’s and St. Michael’s Similarily, Peel & Toronto contribute 58% of the 'Dependency 1' bar, but only 20% of the 'Dependency 5' bar. Healthcare; 2018. Joint publication with Public Health Ontario. Rate of COVID-19 ED Visits Per 10,000 Adult Population, by Material Deprivation & Public Health Unit Adults Only, Jan to Jun 2020 Material Deprivation 1 - Least Marginalized to 5 - Most Marginalized BRANT COUNTY CHATHAM-KENT CITY OF HAMILTON GREY BRUCE HALDIMAND-NORFOLK 16.0 3.6 2.9 2.7 3.5 5.7 6.9 3.9 10.5 7.3 4.7 6.4 9.4 6.5 6.6 7.9 6.7 4.8 6.5 5.4 4.7 7.1 9.3 4.2 10.2 HALTON REGION HURON COUNTY LAMBTON MIDDLESEX-LONDON NIAGARA REGION 25.6 26.7 21.0 20.9 16.0 15.9 10.0 10.4 6.7 12.6 13.1 12.3 8.0 5.2 7.5 11.4 6.2 10.9 7.7 7.0 10.0 6.9 5.0 8.4 8.9 PEEL PERTH DISTRICT REGION OF WATERLOO SOUTHWESTERN TORONTO* 67.2 43.9 43.0 45.5 32.0 35.1 33.1 30.0 30.2 26.8 31.1 26.3 23.2 20.6 24.2 20.2 14.6 16.8 15.3 15.3 14.5 12.9 8.7 13.4 12.9 WDG* WINDSOR-ESSEX Observations: Within certain public health units such as Peel, Region of Waterloo, Toronto*, and Windsor-Essex, the rate of COVID-19 ED visits per population increases as the material deprivation of the patient's neighbourhood increases. 20.5 13.6 17.2 16.1 13.6 19.7 11.1 13.3 8.2 12.4 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 TORONTO*: This figure displays results for only the portion of Toronto Public Health (about half) that is contained in the TC LHIN, CW LHIN and MH LHIN regions. See Appendix A for more information. Wellington-Dufferin-Guelph (WDG)*: This figure only displays results for the Wellington & Guelph portions of this Public Health Region, not the Dufferin Region. See Appendix A for more information. Rate of COVID-19 ED Visits Per 10,000 Adult Population, by Residential Instability & Public Health Unit Adults Only, Jan to Jun 2020 Residential Instability 1 - Least Marginalized to 5 - Most Marginalized BRANT COUNTY CHATHAM-KENT CITY OF HAMILTON GREY BRUCE HALDIMAND-NORFOLK 17.2 14.6 10.5 3.6 3.5 1.2 4.4 6.4 6.1 4.7 4.1 7.0 6.3 7.0 5.8 9.2 8.4 6.0 7.7 5.2 4.7 4.1 6.3 4.4 6.2 HALTON REGION HURON COUNTY LAMBTON MIDDLESEX-LONDON NIAGARA REGION 31.5 24.7 16.4 19.9 20.8 12.4 11.1 11.4 12.9 10.7 9.2 9.1 8.1 9.7 7.8 0.0 7.7 7.6 10.0 7.1 7.3 8.9 1.3 4.4 8.6 PEEL PERTH DISTRICT REGION OF WATERLOO SOUTHWESTERN TORONTO* 49.7 46.6 40.5 42.4 39.4 34.9 33.0 32.0 30.2 26.4 25.4 29.1 30.0 21.2 23.0 17.3 20.9 19.0 17.6 19.2 11.9 14.2 11.9 3.8 9.1 WDG* WINDSOR-ESSEX Observations: Within certain public health units such as the Region of Waterloo and Wellington Dufferin Guelph (WDG) the rate of COVID-19 ED visits per population increases as the residential instability of the patient's neighbourhood increases. 14.3 15.4 16.1 18.1 17.2 18.3 10.0 12.7 12.7 13.4 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 TORONTO*: This figure displays results for only the portion of Toronto Public Health (about half) that is contained in the TC LHIN, CW LHIN and MH LHIN regions. See Appendix A for more information. Wellington-Dufferin-Guelph (WDG)*: This figure only displays results for the Wellington & Guelph portions of this Public Health Region, not the Dufferin Region. See Appendix A for more information. Rate of COVID-19 ED Visits Per 10,000 Adult Population, by Dependency & Public Health Unit Adults Only, Jan to Jun 2020 Dependency 1 - Least Marginalized to 5 - Most Marginalized BRANT COUNTY CHATHAM-KENT CITY OF HAMILTON GREY BRUCE HALDIMAND-NORFOLK 19.6 20.0 18.9 13.3 4.8 4.0 2.8 4.3 3.6 0.0 0.0 3.5 4.2 5.6 7.2 7.8 8.3 8.2 3.6 4.5 5.1 6.2 7.5 4.5 4.1 HALTON REGION HURON COUNTY LAMBTON MIDDLESEX-LONDON NIAGARA REGION 37.0 17.3 19.6 21.8 11.5 11.6 10.8 10.7 13.1 9.4 5.9 8.7 10.2 10.0 5.3 10.2 6.2 9.8 7.1 6.2 7.4 6.4 5.8 7.1 8.1 PEEL PERTH DISTRICT REGION OF WATERLOO SOUTHWESTERN TORONTO* 51.2 44.6 41.8 37.7 40.0 30.3 28.0 31.8 28.5 31.9 29.0 29.7 27.3 27.5 24.1 27.7 18.7 19.3 16.4 16.3 13.0 11.8 12.0 14.7 4.9 WDG* WINDSOR-ESSEX Observations: Within certain public health units such as the City of Hamilton and Windsor-Essex, the rate of COVID-19 ED visits per population increases as the dependency of the patient's neighbourhood increases.
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