Abstract
Objective
To determine whether characteristics of neighbourhoods in which children live, such as socio-economic disadvantage, physical infrastructure, programs and services, social disconnection, smoking prevalence, and overcrowding, are related to hospitalization rates from birth to age six, independent of individual-level factors.
Methods
We studied a population of 8,504 children born in Saskatoon, Canada, over a three-year period (1992-1994). The birth cohort was retrospectively followed until children reached age six. Birth registry records were linked to health care utilization files to create continuous histories of health care utilization for each child. Information on the neighbourhood in which the child’s family resided at his or her birth was extracted from Statistics Canada’s 1991 Census and numerous local sources. A longitudinal and multilevel design was employed to examine the effect of neighbourhood characteristics and individual-level factors on childhood hospitalization rate.
Results
Male children, children born to mothers under 20 years of age, Aboriginal children, children in low-income families, and those with adverse birth outcomes had significantly higher rates of hospitalization. In addition to these individual factors, children living in economically disadvantaged neighbourhoods, neighbourhoods in poor physical condition, and neighbourhoods with higher average household size had significantly higher rates of hospitalization.
Conclusions
The kind of neighbourhood families live in has an impact on their children’s risk of hospitalization, above and beyond the family’s own characteristics. These findings provide additional support for a ‘healthy community’ approach that uses community development and healthy public policy to create safe, health-promoting neighbourhoods for all families.
Key words: Children’s hospitalization, neighbourhood effects, adverse birth outcomes, family income status
Résumé
Objectif
Déterminer si les caractéristiques des quartiers où habitent les enfants comme une situation socioéconomique défavorisée, les infrastructures matérielles, les programmes et les services, la rupture sociale, la prévalence du tabagisme et le surpeuplement, influent sur les taux d’hospitalisation de la naissance à l’âge de six ans, indépendamment des facteurs individuels.
Méthode
Sur une période de trois ans (1992-1994), nous avons étudié une population de 8 504 enfants nés à Saskatoon, au Canada. La cohorte de naissance a été suivie rétrospectivement jusqu’à ce que les enfants atteignent l’âge de six ans. Le registre de naissance a été relié aux dossiers d’utilisation des soins de santé afin d’établir un historique continu de l’utilisation des soins de santé pour chaque enfant. Les renseignements sur les quartiers où résidaient les familles des enfants à leur naissance ont été tirés du Recensement de 1991 de Statistique Canada et de nombreuses sources locales. Nous avons eu recours à une enquête longitudinale et multiniveau pour examiner l’effet des caractéristiques des quartiers et des facteurs individuels sur le taux d’hospitalisation des enfants.
Résultats
Les garçons, les enfants nés de mères de moins de 20 ans, les enfants autochtones, les enfants provenant de familles à faibles revenus, ainsi que les enfants nés en mauvaise santé présentaient des taux d’hospitalisation beaucoup plus élevés. En plus de ces facteurs individuels, les enfants habitant des quartiers défavorisés sur le plan économique, des quartiers délabrés et des quartiers comportant des ménages de taille supérieure à la moyenne avaient des taux d’hospitalisation beaucoup plus élevés.
Conclusion
Le type de quartier où habitent les familles a une incidence sur le risque d’hospitalisation de leurs enfants, au-delà des caractéristiques propres aux familles. Ces résultats fournissent des arguments à l’appui de l’approche dite des « communautés saines », qui utilise le développement communautaire et des politiques publiques favorisant la santé afin d’établir des quartiers sécuritaires et favorables à la santé pour toutes les familles.
Mots clés: hospitalisation des enfants, effets du quartier, maladies du nourrisson et du nouveau-né, revenu familial
Footnotes
Disclaimer: Part of the data (deidentified) used for this study was provided by Saskatchewan’s Ministry of Health. However, the authors take full responsibility for all analyses, interpretation and presentation of the results.
Source of funding: This research was supported through a grant by the Canadian Population Health Initiative, Canadian Institute for Health Information.
Conflict of Interest: None to declare.
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