Trends and inequities in primary and emergency care use among older adults in British Columbia: an analysis across age, sex, income, and rurality (2018–2023)
Year: 2026
Type: article
Study design: Observational Study
Abstract: Access to care in Canada has become increasingly unstable, exacerbated by workforce shortages and the COVID-19 pandemic, which disrupted in-person care and accelerated the shift to virtual modalities. This hugely affects older adults (65+) as a high-need population. Our study addresses gaps in the literature and the trends of health care service utilization by providing a population-level analysis of trends and inequities in primary and emergency care use among older adults in British Columbia (BC) from the pre-pandemic period through to recovery (2018–2023). We conducted a population-based repeated cross-sectional study using linked administrative health data for all BC residents aged 65 years or older, averaging 1.08 million individuals annually. We examined annual trends and calculated population-based rates for Family Physician (FP) visits, virtual visits, Emergency Department (ED) visits, and acute hospital admissions. To assess inequities, we utilized estimated Incidence Rate Ratios (IRRs), stratifying by age, sex, income, and rurality, and evaluating intersectional interactions among these predictors. COVID-19 caused a system-wide shock in 2020; by 2023, in-person outpatient, ED, and hospital utilization remained 7–9% below 2018 levels despite an aging population, suggesting a lower-throughput equilibrium. Conversely, virtual care surged and stabilized at four to five times pre-pandemic levels, indicating a durable shift toward hybrid care. Rural residents exhibited a significantly lower ED use (IRR 0.35) and lower FP visits (IRR 0.97), but higher rates of hospital admissions compared to urban residents; low-income older adults and males relied more on acute care (ED and hospital admission), whereas females had higher rates of FP visits. The oldest-old males (80+) and low-income groups were identified as high-risk clusters for acute care use, facing distinct barriers to longitudinal engagement. The COVID-19 pandemic induced a lasting alteration to the healthcare landscape for older adults in BC. While virtual care has become a permanent fixture, it has not uniformly offset persistent deficits in in-person care. The recovery period has exacerbated structural inequities, revealing an “inverse care” pattern where populations with substantial needs – specifically rural residents, low-income older adults, and older males – face the greatest barriers to preventative care. Among more than one million older adults in British Columbia, in-person outpatient, emergency department, and hospital utilization in 2023 remained 7–9% below 2018 levels despite a substantial aging population. Virtual care stabilized at four to five times pre-pandemic levels, indicating a lasting shift toward hybrid care delivery. Rural residents had lower family physician and emergency department use but higher hospital admissions; low-income older adults had consistently higher emergency department and hospital utilization; and males relied more on acute care than females.
Authors: Anh N. Q. Pham, Julia Smith
Institutions: Simon Fraser University, VinUniversity
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,690
OpenAlex ID: W7154631386