Advertisement

Canadian Journal of Public Health

, Volume 97, Issue 6, pp 435–439 | Cite as

Health Disparity by Neighbourhood Income

  • Mark LemstraEmail author
  • Cory Neudorf
  • Johnmark Opondo
Article
  • 1 Downloads

Abstract

Background

Canadian cities are becoming more segregated by income. As such, investigation is required into the magnitude of health disparity between low-, average- and high-income neighbourhoods in order to quantify the level of health disparity at the scale of an urban city.

Methods

A cross-sectional ecological study design was used to review all hospital discharges, physician visits, medication utilization, public health information and vital statistics for an entire city by neighbourhood income status. Postal code information was used to identify six existing contiguous residential neighbourhoods in the city of Saskatoon that were defined as low-income cut-off neighbourhoods (N=18,228). There were two comparison groups: all other Saskatoon residents (N=184,284) and the five most affluent neighbourhoods in Saskatoon (N=16,683).

Findings

Statistically significant differences in health care utilization by neighbourhood income status were observed for suicide attempts, mental disorders, injuries and poisonings, diabetes, chronic obstructive pulmonary disease, coronary heart disease, chlamydia, gonorrhea, |hepatitis C, teen birth, low birthweight, infant mortality and all-cause mortality. The rate ratios increased in size when comparing low-income neighbourhoods to high-income neighbourhoods. No clear trend was observed for stroke or cancer.

Interpretation

The findings suggest that low-income neighbourhoods are associated with increased health care utilization in Saskatoon.

MeSHterms

Health socioeconomic factors income residence characteristics 

Résumé

Contexte

Les villes canadiennes sont de plus en plus compartimentées selon le revenu, d’où l’intérêt d’étudier l’ampleur des disparités sur le plan de la santé entre les quartiers à revenu faible, moyen et élevé pour quantifier les niveaux de disparité sur le plan de la santé à l’échelle d’une ville.

Méthode

À l’aide d’une étude écologique transversale, nous avons examiné toutes les sorties d’hôpitaux, les visites chez le médecin, la consommation de médicaments, l’information de santé publique et les statistiques démographiques d’une ville entière selon le revenu de ses quartiers. Le code postal a servi à circonscrire six quartiers résidentiels contigus dans la ville de Saskatoon définis comme étant en-dessous du seuil de faible revenu (N=18 228). Nous avons utilisé deux groupes témoins: tous les autres résidents de Saskatoon (N=184 284) et les habitants des cinq quartiers les plus aisés de Saskatoon (N=16 683).

Constatations

Nous avons observé des écarts significatifs dans l’utilisation des soins de santé selon le revenu du quartier en ce qui concerne les tentatives de suicide, les troubles mentaux, les blessures et les empoisonnements, le diabète, les bronchopneumopathies chroniques obstructives, les cardiopathies ischémiques, les chlamydioses, la gonorrhée, l’hépatite C, les accouchements à l’adolescence, l’hypotrophie néonatale, la mortalité infantile et la mortalité toutes causes confondues. Les ratios des taux étaient plus élevés dans les quartiers à faible revenu que dans les quartiers aisés. Aucune tendance claire n’a cependant été observée pour les accidents vasculaires cérébraux, ni pour les cancers.

Interprétation

Ces constatations donnent à penser que les quartiers à faible revenu sont associés à une utilisation accrue des soins de santé à Saskatoon.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Evans RG, Barer ML, Marmor TR. Why Are Some People Healthy and Others Not: The Determinants of Health of Populations. New York, NY: Aldine de Gruyter, 1994.Google Scholar
  2. 2.
    Marmot M. The Status Syndrome: How Social Standing Affects Our Health and Longevity. New York: Henry Holt and Company, 2004.CrossRefGoogle Scholar
  3. 3.
    Mackenbach JP, Kunst AE, Cavelaars AE, Groenhof F, Geurts JJ. Socioeconomic inequalities in morbidity and mortality in Western Europe. The EU Working Group on Socioeconomic Inequalities in Health. Lancet 1997;349:1655–59.CrossRefGoogle Scholar
  4. 4.
    Black D, Morris JN, Smith C, Townsend P. Inequalities in health: The Black Report. Middlesex, UK: Penguin, 1982.Google Scholar
  5. 5.
    Marmot MG. Social Inequalities in Mortality: The Social Environment. Class and Health: Research and Longitudinal Data. London, UK: Tavistock, 1986.Google Scholar
  6. 6.
    Moy E, Arispe IE, Homes JS, Andrews RM. Preparing the national healthcare disparities report: Gaps in data for assessing racial, ethnic and socioeconomic disparities in health care. Med Care 2005;43(3 Suppl):9–16.Google Scholar
  7. 7.
    Dalstra JA, Kunst AE, Borrell C, Breeze E, Cambois E, Costa G, et al. Socioeconomic differences in the prevalence of common chronic diseases: An overview of eight European countries. Int J Epidemiol 2005;34:316–26.CrossRefGoogle Scholar
  8. 8.
    Lorant V, Deliege D, Eaton W, Robert A, Philippot P, Ansseau M. Socioeconomic inequalities in depression: A meta-analysis. Am J Epidemiol 2003;157:98–112.CrossRefGoogle Scholar
  9. 9.
    Sampson RJ, Morenoff JD, Gannon-Rowley T. Assessing neighbourhood effects: Social processes and new directions in research. Annu Rev Sociol 2002;28:443–78.CrossRefGoogle Scholar
  10. 10.
    Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Mezler MM, et al. Socioeconomic status in health research: One size does not fit all. JAMA 2005;294:2879–88.CrossRefGoogle Scholar
  11. 11.
    Picket KE, Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: A critical review. J Epidemiol Community Health 2001;55:111–22.CrossRefGoogle Scholar
  12. 12.
    Robert SA. Socioeconomic position and health: Independent contribution of community socio-economic context: A critical review. Annu Rev Sociol 1999;25:489–516.CrossRefGoogle Scholar
  13. 13.
    Yen IH, Syme SL. The social environment and health: A discussion of the epidemiological literature. Annu Rev Public Health 1999;20:287–308.CrossRefGoogle Scholar
  14. 14.
    Ross NA, Tremblay S, Graham K. Neighbourhood influences on health in Montreal, Canada. Soc Sci Med 2004;59(7):1485–94.CrossRefGoogle Scholar
  15. 15.
    Pampalon R, Duncan C, Subramanian SV, Jones K. Geographies of health perception in Quebec: A multilevel perspective. Soc Sci Med 1999;48(10):1483–90.CrossRefGoogle Scholar
  16. 16.
    Tremblay S, Ross NA, Berthelot JM. Regional socio-economic context and health. Health Reports 2002;13:1–12.Google Scholar
  17. 17.
    Statistics Canada. 2001 Population Census. Ottawa, ON: Statistics Canada, 2005.Google Scholar
  18. 18.
    Statistics Canada. Income Research Paper Series: Low Income Cutoffs from 1994–2003 and Low Income Measures from 1992–2001. (Catalogue no. 75F0002MIE — no. 0002). Ottawa: Statistics Canada, 2004.Google Scholar
  19. 19.
    World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death. Ninth Revision. Geneva, Switzerland, 1977.Google Scholar
  20. 20.
    Liu L, Reeder B, Shuaib A, Mazagri R. Validity of stroke diagnosis on hospital discharge records in Saskatchewan, Canada: Implications for stroke surveillance. Cerebrovascular Diseases 1999;9:224–30.CrossRefGoogle Scholar
  21. 21.
    Rothman KJ, Greenland S. Modern Epidemiology. Philadelphia, PA: Lippincott Williams and Wilkins, 1998.Google Scholar
  22. 22.
    Boyle MH, Willms D. Place effects for areas defined by administrative boundaries. Am J Epidemiol 1999;149(6):577–85.CrossRefGoogle Scholar
  23. 23.
    Macintyre S, Ellaway A, Cummins S. Place effects on health: How can we conceptualise, operationalise and measure them? Soc Sci Med 2002;55(1):125–39.CrossRefGoogle Scholar
  24. 24.
    Raphael D, Macdonald J, Colman R, Labonte R, Hayward K, Torgenson R. Researching income and income distribution as determinants of health in Canada: Gaps between theoretical knowledge, research practice and policy implementation. Health Policy 2005;72:217–32.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2006

Authors and Affiliations

  1. 1.Saskatoon Health RegionSaskatoonCanada

Personalised recommendations