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Neighbourhood, Family and Health Care

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Abstract

Objective

The effects of family and place on health outcomes may be seriously misestimated by standard analytic techniques. The information-rich settings in several Canadian provinces can provide appropriate designs to minimize biases resulting from omitted variables and measurement error. This paper compares siblings with children living in the same neighbourhood (but not in the same family) in terms of health care utilization and health care costs. A complete history of residential mobility since birth permits an estimate of the effects of exposure to different environments.

Methods

Registry data from a Manitoba cohort born between 1978 and 1985 and continuously resident in the province generated a large sample of same-sex siblings and neighbours (N= 18,280). Administrative information on physician billings, hospital inpatient stays, and costs provided data on utilization between ages 12 and 17.

Results

Large effects on the outcome variables were associated with being in the same family (correlations up to 0.50), whereas the correlations representing upper limits on neighbourhood effects were usually small. These neighbourhood correlations typically shrank slightly after adjustment for family effects. Higher neighbour correlations with utilization (particularly ambulatory visits) occurred in rural Manitoba and probably reflect variation in access to care. Higher correlations are associated with relatively small neighbourhoods and with families remaining in the neighbourhood for at least 17 years.

Discussion

Although specific variables taken from administrative data are only marginally predictive, our results emphasize the importance of “family” in affecting health care utilization in Manitoba. The minimal effects of neighbourhood differ from those found by investigators generally using weaker designs and emphasizing the significance of neighbourhood.

Résumé

Objectif

L’influence de la famille et du lieu sur les résultats sanitaires peut être gravement mésestimée par les techniques d’analyse ordinaires. Les milieux riches en information qui existent dans plusieurs provinces canadiennes peuvent présenter des modèles d’étude appropriés lorsqu’on veut réduire les biais dus à l’omission de variables et aux erreurs de mesure. Dans cet article, nous comparons des frères et sœurs avec des enfants vivant dans le même quartier (mais pas dans la même famille) du point de vue de leur utilisation des soins de santé et des coûts des soins de santé reçus. En ayant les antécédents complets de la mobilité résidentielle depuis la naissance, il est possible d’estimer les effets de l’exposition à différents milieux.

Méthode

Nous avons utilisé les données du registre manitobain pour une cohorte née entre 1978 et 1985 et ayant continuellement résidé dans la province pour produire un vaste échantillon de frères et sœurs et de voisins du même sexe (N= 18 280). Des données administratives sur les factures de médecins, les hospitalisations et les coûts ont permis de calculer les taux d’utilisation des services de santé par les enfants de 12 à 17 ans.

Résultats

D’importants effets étaient associés au fait d’appartenir à la même famille (corrélations avec les variables de résultat pouvant aller jusqu’à 0,50), tandis que les corrélations importantes (aux limites supérieures) pour l’influence du quartier étaient faibles dans l’ensemble. Ces corrélations relatives au quartier diminuaient en général légèrement lorsqu’on tenait compte des effets familiaux. Des corrélations plus fortes entre le quartier et l’utilisation des services de santé (en particulier les visites sur pied) ont été observées dans les régions rurales du Manitoba; elles traduisent probablement des écarts dans l’accès aux soins. Les corrélations les plus fortes sont associées aux quartiers relativement petits et aux familles ayant habité le quartier pendant au moins 17 ans.

Analyse

Les variables particulières tirées des données administratives n’ont qu’une valeur prédictive marginale, mais nos résultats soulignent l’important effet de la « famille » sur l’utilisation des soins de santé au Manitoba. Les effets minimes du quartier diffèrent de ceux trouvés par les chercheurs qui utilisent en général des modèles d’étude plus faibles et qui mettent l’accent sur l’importance du quartier.

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Authors and Affiliations

  1. Manitoba Centre for Health Policy, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, RM 408 — 727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada

    Leslie L. Roos PhD & Randy Walld MSc, B Comm (Hons)

Authors
  1. Leslie L. Roos PhD
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  2. Randy Walld MSc, B Comm (Hons)
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Corresponding author

Correspondence to Leslie L. Roos PhD.

Additional information

Acknowledgements: This research was funded by the Canadian Institutes of Health Research (Manitoba Health Project Numbers 2004/2005–18 and 25), the Canadian Population Health Initiative (Manitoba Health Project Number 2000/2001–23) and the Manitoba Centre for Health Policy. The results and conclusions are those of the authors, and no official endorsement by Manitoba Health was intended or should be inferred. We are indebted to Health Information Management, Manitoba Health, and Statistics Canada for providing data. This research was approved by the Research Ethics Board, Faculty of Medicine, University of Manitoba, and by the Health Information Privacy Committee, Manitoba Health. The authors also thank Jo-Anne Baribeau and Theresa Daniuk for manuscript preparation.

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Roos, L.L., Walld, R. Neighbourhood, Family and Health Care. Can J Public Health 98 (Suppl 1), S54–S61 (2007). https://doi.org/10.1007/BF03403727

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