Poverty and Cumulative Hospitalization in Infancy and Early Childhood in the Quebec Birth Cohort: A Puzzling Pattern of Association
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Objective: We anticipate a negative gradient between income and hospitalization, since income is positively associated with good health. In a previous cross-sectional study, we reported an unexpected pattern of association between poverty and hospitalization for 5-month-old infants in Quebec. This study re-examines the poverty–hospitalization relationship within a longitudinal population study of the same birth cohort aged 3.5 years. Method: Life table analysis, multivariable proportional hazard regression, and multivariable logistic regression were performed on data from the first four waves of the Quebec Longitudinal Study of Child Development (QLSCD). Probabilities of hospitalization were estimated by poverty status. The hazard ratios (HR) (Cox-regression) for duration of poverty (frequency of insufficient income) and severity of poverty (combining frequency and level of income insufficiency) were estimated, controlling for predisposing, enabling, and need determinants of hospitalization. Results: At 3.5 years, 31% of children had been hospitalized at least once. Compared with children whose families had constantly sufficient income, children with intermittent poverty exhibited higher hospitalization risks (HR = 1.30; 95%CI = 1.04–1.64) while chronically poor children exhibited comparable hospitalization hazards (HR = 0.97; 95%CI = 0.73–1.27). Hospitalization risks for children in the severest poverty group resembled that of the non-poor group (HR = 0.99; 95%CI = 0.66–1.49), while children in less severely poor families were more likely to be hospitalized (HR = 1.26; 95%CI = 0.99–1.60). Conclusion: Results suggest hospitalization barriers for children living in chronic and severe poverty. If these barriers exist in a universal health care system, they may originate with primary care service organization or hospital care referral procedures.
KeywordsPoverty Hospitalization Child health Québec
This study was supported by the Canadian institute of Health Research (CIHR) Grant Number200309MOP-123079 and by The Insitut de la Statistique du Québec, Direction Santé Québec.
- 8.Paquet, G., Girard, M., & Dubois, L. (2001). Standard of living, health and development, Part II – social inequality and child development. In Longitudinal study of child development in Québec (ÉLDEQ 1998–2002) (Vol. 1, No. 3). Québec: Institut de la statistique du Québec.Google Scholar
- 9.Paquet, G., & Hamel, D. (2003). Inégalité sociales et santé des tout-petits: l’identification de facteurs de protection. Québec: Institut national de santé publique du Québec.Google Scholar
- 10.Paquet, G., & Hamel, D. (2005). Shoring up the health of young children at the low end of the social scale. In Québec longitudinal study of child development (QLSCD 1998–2002) – from birth to 4 years old (Vol. 3, Fascicle 4). Québec: Institut de la statistique du Québec.Google Scholar
- 12.Séguin, L., Xu, Q., Gauvin, L., Zunzunegui, M. V., Potvin, L., & Frohlich, K. L. (2005). Understanding the dimensions of socioeconomic status that influence toddlers’ health: Unique impact of lack of money for basic needs in Quebec’s birth cohort. Journal of Epidemiology and Community health, 59(1), 42–48.PubMedCrossRefGoogle Scholar
- 14.Simpson, L., Owens, P. L., Zodet, M. W., Chevarley, F. M., Dougherty, D. A. E., et al. (2005). Health care for children and youth in the United States: Annual report on patterns of coverage, utilization, quality, and expenditures by income. Ambulatory Pediatrics, 5(1), 6–44.PubMedCrossRefGoogle Scholar
- 16.Séguin, L., Kantiébo, M., Xu, Q., Zunzunegui, M.-V., Potvin, L., Frohlich, K. L., & Dumas, C. (2001). Standard of living, health and development, Part I – poverty, health conditions at birth and infant health. In Longitudinal study of child development in Québec (ÉLDEQ 1998–2002) (Vol. 1, No. 3). Québec: Institut de la Statistique du Québec.Google Scholar
- 20.Lethbridge, L. N., & Phipps, S. A. (2005). Chronic poverty and childhood asthma in the Maritimes versus the rest of Canada. Canadian Journal of Public Health, 96(1), 18–23.Google Scholar
- 22.Smith, L. A., Hatcher-Ross, J. L., Wertheimer R., & Kahn, R. S. (2005). Rethinking race/ethnicity, income, and childhood asthma: Racial/ethnic disparities concentrated among the very poor. Public Health Report, 120(2), 109–116.Google Scholar
- 26.Paquet, B. (2002). Low income cutoffs from 1992 to 2001 and low income measures from 1991 to 2000. Ottawa: Minister of Industry. http://www.statcan.ca/cgi-bin/downpub/research.cgi
- 33.Sword, W. A., Watt, S., Krueger, P. D., Kyong, S. L., Sheehan, D. D., Roberts, J. G., et al. (2001). Understanding newborn infant readmission: Findings of the Ontario Mother and Infant Survey. Canadian Journal of Public Health, 92(3), 196–200.Google Scholar