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Canadian Journal of Public Health

, Volume 108, Issue 3, pp e257–e264 | Cite as

Pediatric ambulatory care sensitive conditions: Birth cohorts and the socio-economic gradient

  • Leslie L. RoosEmail author
  • Roxana Dragan
  • Robert J. Schroth
Quantitative Research
  • 1 Downloads

Abstract

OBJECTIVES: This study examines the socio-economic gradient in utilization and the risk factors associated with hospitalization for four pediatric ambulatory care sensitive conditions (dental conditions, asthma, gastroenteritis, and bacterial pneumonia). Dental conditions, where much care is provided by dentists and insurance coverage varies among different population segments, present special issues.

METHODS: A population registry, provider registry, physician ambulatory claims, and hospital discharge abstracts from 28 398 children born in 2003–2006 in urban centres in Manitoba, Canada were the main data sources. Physician visits and hospitalizations were compared across neighbourhood income groupings using rank correlations and logistic regressions.

RESULTS: Very strong relationships between neighbourhood income and utilization were highlighted. Additional variables - family on income assistance, mother’s age at first birth, breastfeeding - helped predict the probability of hospitalization. Despite the complete insurance coverage (including visits to dentists and physicians and for hospitalizations) provided, receiving income assistance was associated with higher probabilities of hospitalization.

CONCLUSIONS: We found a socio-economic gradient in utilization for pediatric ambulatory care sensitive conditions, with higher rates of ambulatory visits and hospitalizations in the poorest neighbourhoods. Insurance coverage which varies between different segments of the population complicates matters. Providing funding for dental care for Manitobans on income assistance has not prevented physician visits or intensive treatment in high-cost facilities, specifically treatment under general anesthesia. When services from one type of provider (dentist) are not universally insured but those from another type (physician) are, using rates of hospitalization to indicate problems in the organization of care seems particularly difficult.

Key Words

Pediatric dental conditions early childhood caries physician visits hospitalizations birth cohorts socio-economic gradient 

Résumé

OBJECTIFS: Notre étude porte sur le gradient socioéconomique du recours à l’hospitalisation et sur les facteurs de risque associés pour quatre conditions pédiatriques propices aux soins ambulatoires (problèmes dentaires, asthme, gastroentérite et pneumonie bactérienne). Les problèmes dentaires présentent des enjeux particuliers, car la plupart sont traités par des dentistes, et la couverture d’assurance de ces soins varie selon le segment démographique.

MÉTHODE: Nos données provenaient principalement d’un registre de population, d’un registre des fournisseurs, des demandes de paiement des médecins pour consultations en médecine ambulatoire et du registre des sorties des hôpitaux de 28 398 enfants nés entre 2003 et 2006 dans les centres urbains du Manitoba, au Canada. Nous avons comparé les visites chez le médecin et les hospitalisations pour différents groupes de revenu selon le quartier à l’aide de corrélations des rangs et de régressions logistiques.

RÉSULTATS: Des liens très solides sont apparus entre le revenu selon le quartier et le recours à l’hospitalisation. D’autres variables - le fait pour la famille de toucher une aide au revenu, l’âge de la mère à la première naissance, l’allaitement maternel - ont aidé à prédire la probabilité d’hospitalisation. Malgré la couverture d’assurance complète assortie à l’aide au revenu (y compris les visites chez le dentiste et le médecin et les hospitalisations), le fait de toucher une telle aide était associé à des probabilités d’hospitalisation supérieures.

CONCLUSIONS: Nous avons constaté la présence d’un gradient socioéconomique dans le recours à l’hospitalisation pour les conditions pédiatriques propices aux soins ambulatoires, avec des taux de visites sur pied et d’hospitalisation plus élevés dans les quartiers les plus pauvres. La couverture d’assurance, qui varie selon le segment démographique, complique encore les choses. Le financement des soins dentaires des Manitobains prestataires de l’aide au revenu n’a pas empêché les visites chez le médecin ni les traitements intensifs dans des installations à coût élevé, plus précisément les traitements sous anesthésie générale. En l’absence d’une couverture universelle des services d’une catégorie de fournisseurs (les dentistes) alors qu’une telle couverture existe pour les services d’une autre catégorie de fournisseurs (les médecins), il semble particulièrement difficile d’utiliser les taux d’hospitalisation pour repérer des problèmes dans l’organisation des soins.

Mots Clés

problèmes dentaires pédiatriques caries du jeune enfant visites chez le médecin hospitalisations cohortes de naissance gradient socioéconomique 

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Copyright information

© The Canadian Public Health Association 2017

Authors and Affiliations

  • Leslie L. Roos
    • 1
    Email author
  • Roxana Dragan
    • 1
  • Robert J. Schroth
    • 2
  1. 1.Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
  2. 2.Department of Preventive Dental Science, College of Dentistry, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada

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