{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T18:01:52Z","timestamp":1789322512477,"version":"build-2803163510"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T00:00:00Z","timestamp":1730073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research Institute of St. Joe\u2019s Hamilton"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nIntroduction<\/jats:title>\nThe influence of neighborhood characteristics and socioeconomic status (SES) factors on avoidable emergency department (ED) utilization is not well understood in a universal healthcare system. We examined correlations between these factors and avoidable ED visits at a Canadian academic hospital.<\/jats:p>\n<\/jats:sec>\n\nMaterials and methods<\/jats:title>\nWe conducted a retrospective cohort study using administrative ED data from a hospital in Hamilton, Canada from April 1, 2018 to August 31, 2023, and neighborhood data from the Statistics Canada Census of Population 2021. Avoidable visits were classified using the Emergency Department Avoidability Classification (EDAC), and mapped to neighborhoods using Canadian postal codes. SES was defined primarily based on education attained, household income, employment and housing security. The top 20 postal codes with the highest avoidable ED visits were categorized into quartiles and analyzed for trends using chi-squared tests of spatial association and Spearman rank correlations.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nA consistent ordinal trend across quartiles was observed throughout the study period, with quartile 1 representing the lowest avoidable ED visits and quartile 4 the highest. The quartiles were unevenly distributed spatially, though there was a significant association between close proximity to the ED and avoidable visits (X2<\/jats:sup> = 7.07, p <0.05). The quartile with the highest avoidable ED visits (quartile 4) had the greatest proportion of one-person households (35.5%) and one-parent families (37.8%), and showed statistically significant positive correlations with male sex, living alone and having an indigenous identity. Quartile 4 had the highest rates of individuals not completing high school (18.6%, p < 0.05), unemployment (13.7%), households spending greater than 30% of their income on shelter (26.5%), and households earning less than $30,000 annually (16.6%, compared to 8.7% in quartile 1 with the lowest avoidable ED visits).<\/jats:p>\n<\/jats:sec>\n\nDiscussion<\/jats:title>\nIn a universal healthcare setting, lower SES neighborhoods were correlated with higher rates of avoidable ED visits. Targeted interventions that address social determinants of health disparities in neighborhoods with lower SES could reduce the burden of avoidable ED visits, and promote more equitable healthcare utilization.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0311575","type":"journal-article","created":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T17:28:23Z","timestamp":1730136503000},"page":"e0311575","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Neighborhood socioeconomic factors and characteristics correlated with avoidable emergency department visits: A spatial analysis of a Canadian academic hospital"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1902-4734","authenticated-orcid":true,"given":"Ryan 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Health"},{"key":"pone.0311575.ref002","doi-asserted-by":"crossref","first-page":"231","DOI":"10.3389\/fpubh.2020.00231","article-title":"Socioeconomic Status and Access to Healthcare: Interrelated Drivers for Healthy Aging","volume":"8","author":"DJ McMaughan","year":"2020","journal-title":"Front Public Health"},{"issue":"2","key":"pone.0311575.ref003","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.joep.2009.10.008","article-title":"Socioeconomic status, neighborhood disadvantage, and poverty-related stress: Prospective effects on psychological syndromes among diverse low-income families","volume":"32","author":"CD Santiago","year":"2011","journal-title":"Journal of Economic Psychology"},{"issue":"5","key":"pone.0311575.ref004","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1111\/1475-6773.00174","article-title":"Disparities in Adolescent Health and Health Care: Does Socioeconomic Status Matter?","volume":"38","author":"PW Newacheck","year":"2003","journal-title":"Health Serv Res"},{"issue":"2","key":"pone.0311575.ref005","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/HJH.0000000000000428","article-title":"Socioeconomic status and hypertension: a meta-analysis","volume":"33","author":"B Leng","year":"2015","journal-title":"J Hypertens"},{"issue":"2","key":"pone.0311575.ref006","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.jemermed.2006.05.042","article-title":"The emergency department for routine healthcare: Race\/ethnicity, socioeconomic status, and perceptual factors","volume":"32","author":"R Hong","year":"2007","journal-title":"Journal of Emergency Medicine"},{"issue":"9","key":"pone.0311575.ref007","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1111\/jpc.16450","article-title":"The impact of low socioeconomic status and primary health care access on emergency department presentations in young children in regional Queensland","volume":"59","author":"C McCosker","year":"2023","journal-title":"Journal of Paediatrics and Child Health"},{"issue":"1","key":"pone.0311575.ref008","doi-asserted-by":"crossref","first-page":"e0297689","DOI":"10.1371\/journal.pone.0297689","article-title":"Validating the Emergency Department Avoidability Classification (EDAC): A cluster randomized single-blinded agreement study","volume":"19","author":"RP Strum","year":"2024","journal-title":"PLOS ONE"},{"issue":"9","key":"pone.0311575.ref009","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1377\/hlthaff.2009.0748","article-title":"Many Emergency Department Visits Could Be Managed At Urgent Care Centers And Retail Clinics","volume":"29","author":"RM Weinick","year":"2010","journal-title":"Health Affairs"},{"issue":"2","key":"pone.0311575.ref010","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.annemergmed.2008.03.014","article-title":"Systematic review of emergency department crowding: causes, effects, and solutions","volume":"52","author":"NR Hoot","year":"2008","journal-title":"Ann Emerg Med"},{"issue":"1","key":"pone.0311575.ref011","first-page":"47","article-title":"Deciding to Visit the Emergency Department for Non-Urgent Conditions: A Systematic Review of the Literature","volume":"19","author":"L Uscher-Pines","year":"2013","journal-title":"Am J Manag Care"},{"issue":"7624","key":"pone.0311575.ref012","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"335","author":"E von Elm","year":"2007","journal-title":"BMJ"},{"issue":"02","key":"pone.0311575.ref013","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1017\/S1481803500009854","article-title":"Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) adult guidelines","volume":"10","author":"the CTAS National Working Group","year":"2008","journal-title":"CJEM"},{"key":"pone.0311575.ref014","unstructured":"Canadian Institute for Health Information. Canadian Coding Standards for Version 2018 ICD-10-CA and CCI. CIHI; 2018."},{"key":"pone.0311575.ref015","unstructured":"Statistics Canada. 2021 Census of Population collection response rates [Internet]. 2021. https:\/\/www12.statcan.gc.ca\/census-recensement\/2021\/ref\/response-rates-eng.cfm"},{"issue":"12","key":"pone.0311575.ref016","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1097\/MLR.0b013e318270bad4","article-title":"Disparities in potentially avoidable emergency department (ED) care: ED visits for ambulatory care sensitive conditions","volume":"50","author":"PJ Johnson","year":"2012","journal-title":"Med Care"},{"issue":"8","key":"pone.0311575.ref017","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1111\/j.1553-2712.2011.01127.x","article-title":"A population-based study of the association between socioeconomic status and emergency department utilization in Ontario, Canada","volume":"18","author":"Y Khan","year":"2011","journal-title":"Acad Emerg Med"},{"issue":"2","key":"pone.0311575.ref018","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1111\/1467-9566.ep10487794","article-title":"The Role of Proximity in the Use of Hospital Emergency Departments","volume":"2","author":"G. Magnusson","year":"1980","journal-title":"Sociology of Health & Illness"},{"key":"pone.0311575.ref019","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s12939-015-0158-y","article-title":"Travel distance and sociodemographic correlates of potentially avoidable emergency department visits in California, 2006\u20132010: an observational study","volume":"14","author":"BK Chen","year":"2015","journal-title":"Int J Equity Health"},{"issue":"3","key":"pone.0311575.ref020","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.jemermed.2009.08.058","article-title":"Geography and Travel Distance Impact Emergency Department Visits","volume":"40","author":"PL Henneman","year":"2011","journal-title":"The Journal of Emergency Medicine"},{"key":"pone.0311575.ref021","unstructured":"Ontario College of Family Physicians. Ontario College of Family Physicians. 2023. More Than Four Million Ontarians Will Be Without a Family Doctor by 2026. https:\/\/ontariofamilyphysicians.ca\/news\/more-than-four-million-ontarians-will-be-without-a-family-doctor-by-2026\/"},{"issue":"9","key":"pone.0311575.ref022","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1111\/acem.13220","article-title":"Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis","volume":"24","author":"JE Coster","year":"2017","journal-title":"Acad Emerg Med"},{"issue":"12","key":"pone.0311575.ref023","doi-asserted-by":"crossref","first-page":"e0227007","DOI":"10.1371\/journal.pone.0227007","article-title":"Health literacy as a mediator of the relationship between socioeconomic status and health: A cross-sectional study in a population-based sample in Florence","volume":"14","author":"Florence Health Literacy Research Group","year":"2019","journal-title":"PLoS One"},{"issue":"12","key":"pone.0311575.ref024","doi-asserted-by":"crossref","first-page":"e0145455","DOI":"10.1371\/journal.pone.0145455","article-title":"The Relationship between Health Literacy and Health Disparities: A Systematic Review","volume":"10","author":"S Mantwill","year":"2015","journal-title":"PLoS One"},{"key":"pone.0311575.ref025","doi-asserted-by":"crossref","first-page":"21501319221082352","DOI":"10.1177\/21501319221082352","article-title":"Exploring Primary Care Non-Attendance: A Study of Low-Income Patients","volume":"13","author":"KA Chapman","year":"2022","journal-title":"J Prim Care Community Health"},{"key":"pone.0311575.ref026","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1186\/s12939-023-02050-x","article-title":"Emergency department care experiences among people who use substances: a qualitative study","volume":"22","author":"D Rajab","year":"2023","journal-title":"Int J Equity Health"},{"issue":"7","key":"pone.0311575.ref027","doi-asserted-by":"crossref","first-page":"e2117052","DOI":"10.1001\/jamanetworkopen.2021.17052","article-title":"Physician Use of Stigmatizing Language in Patient Medical Records","volume":"4","author":"J Park","year":"2021","journal-title":"JAMA Network Open"},{"issue":"1","key":"pone.0311575.ref028","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12916-019-1256-2","article-title":"Stigma in health facilities: why it matters and how we can change it","volume":"17","author":"L Nyblade","year":"2019","journal-title":"BMC Medicine"},{"issue":"6","key":"pone.0311575.ref029","doi-asserted-by":"crossref","first-page":"E263","DOI":"10.1503\/cmaj.121383","article-title":"The effect of socioeconomic status on access to primary care: an audit study","volume":"185","author":"ME Olah","year":"2013","journal-title":"CMAJ"},{"issue":"2","key":"pone.0311575.ref030","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1111\/1475-6773.13246","article-title":"Outcomes of primary care delivery by nurse practitioners: Utilization, cost, and quality of care","volume":"55","author":"C Liu","year":"2020","journal-title":"Health Serv Res"},{"issue":"6","key":"pone.0311575.ref031","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1017\/cem.2019.379","article-title":"What do community paramedics assess? 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