Relationship Between Social Inequalities and Ambulatory Care–Sensitive Hospitalizations Persists for up to 9 Years among Children Born in a Major Canadian Urban Center

doi:10.1016/j.ambp.2007.02.005

Ambulatory Pediatrics

Volume 7, Issue 3, May 2007, Pages 258-262

https://doi.org/10.1016/j.ambp.2007.02.005 Get rights and content

Objective

Hospitalizations for ambulatory care–sensitive (ACS) conditions have been considered a marker for access to timely and effective primary care, but there are few pediatric studies. Our purpose was to examine socioeconomic disparities in ACS and non-ACS admissions among birth cohorts in a universal health insurance setting.

Methods

We examined ACS and all hospitalizations of children born from 1993 to 2000 in Toronto, Canada, by birth year, calendar year, and socioeconomic status (SES). SES was evaluated by using quintiles of mean neighborhood income from the 1996 Canadian census. Cohort, age, and temporal effects were described for all admissions, ACS admissions, and specific ACS conditions. Attributable risk by SES was calculated by using rates for the highest and lowest SES quintiles.

Results

Among 255 284 children born in Toronto during 1993–2001, ACS conditions were responsible for 28% of hospitalizations during the first 2 years of life and close to half of admissions during the third year. Low income was associated with 50% higher rates of ACS hospitalizations (relative risk [RR] = 1.50, 95% confidence interval [95% CI] 1.43–1.58), including asthma (RR = 1.69, 95% CI 1.54–1.86) and bacterial pneumonia (RR = 1.59, 95% CI 1.40–1.81), the leading causes of admission. Socioeconomic disparities in ACS and all admissions occurred in every cohort, every calendar year, and every age group.

Conclusions

The relationship between socioeconomic disadvantage and both ACS and all-cause hospitalization in children was large, consistent across many conditions, remained stable over time, and persisted up to 9 years of age. These effects occurred in a universal health insurance setting without direct financial barriers to physician or hospital care. The effect of SES on hospitalizations in children in our setting appears to be mediated by factors other than financial access to care.

Section snippets

Methods

The study population consists of all children born in Toronto between 1993 and 2000. Toronto is the largest city in Canada with an economically and ethnically diverse population of approximately 2.5 million people in 2001.

Results

There were 255 284 children born in hospital in Toronto during 1993–2001, more than 39% (100 260) in income quintile 1 and 8% (21 793) in quintile 5. The other 3 quintiles (Q2, Q3, and Q4), on average, have about 17% (44 410) of the newly born. Income quintile 1 had the highest proportion of the population living below Statistics Canada’s low-income cutoff (42%), having immigrated to Canada within the previous 5 years (17%), and having families headed by one parent (26%). Quintile 1 also had

Discussion

Our major finding is that the relationship between socioeconomic disadvantage and ACS hospitalization was large, consistent across many conditions, stable over time, and persistent up to 9 years of age. These effects occurred in a universal health insurance setting without direct financial barriers to physician or hospital care. Few studies have examined the long-term pattern of hospitalization for ACS conditions in cohorts of children. Our findings indicate that ACS conditions are responsible

Acknowledgments

This study was supported by the Centre for Research on Inner City Health at St Michael’s Hospital in Toronto, the Institute for Clinical Evaluative Sciences in Toronto, the Canadian Institutes of Health Research, and the Ontario Ministry of Health and Long-Term Care. The opinions, results, and conclusions are those of the authors, and no endorsement by the ministry is intended or should be inferred.

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Brief reportBehavior and hospitalizationRelationship Between Social Inequalities and Ambulatory Care–Sensitive Hospitalizations Persists for up to 9 Years among Children Born in a Major Canadian Urban Center

Objective

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Acknowledgments

Ambul Pediatr

Chest

Inequalities in access to medical care by income in developed countries

CMAJ

Variation in hospital discharges for ambulatory care–sensitive conditions among children

Pediatrics

Potentially preventable care: ambulatory care–sensitive pediatric hospitalizations in South Carolina in 1998

South Med J

Recent findings on preventable hospitalizations

Health Aff (Millwood)

Impact of socioeconomic status on hospital use in New York City

Health Aff (Millwood)

Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland

JAMA

Preventable hospitalizations and access to health care

JAMA

Primary care physicians and avoidable hospitalizations

J Fam Pract

Physician visits, hospitalizations, and socioeconomic status: ambulatory care sensitive conditions in a Canadian setting

Health Serv Res

Pediatric hospitalization due to ambulatory care–sensitive conditions in Valencia (Spain)

Int J Qual Health Care

Health care for children and youth in the United States: annual report on patterns of coverage, utilization, quality, and expenditures by income

Ambul Pediatr

Increased rates of morbidity, mortality, and charges for hospitalized children with public or no health insurance as compared with children with private insurance in Colorado and the United States

Pediatrics

Continuing decline in acute asthma episodes in the community

Arch Dis Child

Brief report
Behavior and hospitalization
Relationship Between Social Inequalities and Ambulatory Care–Sensitive Hospitalizations Persists for up to 9 Years among Children Born in a Major Canadian Urban Center