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.
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.
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Lemstra, M., Neudorf, C. & Opondo, J. Health Disparity by Neighbourhood Income. Can J Public Health 97, 435–439 (2006). https://doi.org/10.1007/BF03405223
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DOI: https://doi.org/10.1007/BF03405223