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Canadian Journal of Public Health = Revue Canadienne de Santé Publique logoLink to Canadian Journal of Public Health = Revue Canadienne de Santé Publique
. 2000 Jul 1;91(4):268–273. doi: 10.1007/BF03404286

The Nature of Increased Hospital Use in Poor Neighbourhoods: Findings from a Canadian Inner City

Richard H Glazier 18,28,38,48,58,68,, Elizabeth M Badley 28,48,58,78, Julie E Gilbert 38, Lorne Rothman 88
PMCID: PMC6979985  PMID: 10986783

Abstract

The relationship between socioeconomic factors and hospital use is not well understood in the Canadian context. We used the 1991 Canada census and 1990–92 Ontario hospital discharge abstracts for residents of southeast Toronto to calculate crude and age-sex adjusted rates of hospital admission, bed days, and costs by quintile of low-income households. Population-based rates of admission to hospital, bed days and costs were all significantly related to census tract income (p<0.01 for males and females). The number of admissions per person admitted was significantly associated with census tract income (p<0.01 for males and females), but length of stay and resource intensity weight were not. Hospital costs were 50.0% higher for the poorest quintile of neighbourhoods than for the wealthiest and 35.8% higher than for the middle-income quintile. Poor urban neighbourhoods may require more resources than previously anticipated, related to higher hospital admission and readmission rates.

Footnotes

Supported by grants from the Pan American Health Organization and the Wellesley Hospital Urban Health Initiative

References

  • 1.Graunt J. Natural and Political Observations Mentioned in a Following Index and Made Upon the Bills of Mortality. London: Roycroft; 1662. [Google Scholar]
  • 2.Beveridge W. Social Insurance and Allied Services. New York: Macmillan; 1942. [PMC free article] [PubMed] [Google Scholar]
  • 3.Frank JW, Mustard JF. The determinants of health from a historical perspective. Proceedings of the American Academy of Arts and Sciences. 1994;123:1. [PubMed] [Google Scholar]
  • 4.Marmot MG, Shipley MJ, Rose G. Inequalities in death-specific explanations of a general pattern? Lancet. 1984;1:1003. doi: 10.1016/S0140-6736(84)92337-7. [DOI] [PubMed] [Google Scholar]
  • 5.Manga P, Broyles RW, Angus DE. The determinants of hospital utilization under a universal public insurance program in Canada. Medical Care. 1987;25:658. doi: 10.1097/00005650-198707000-00009. [DOI] [PubMed] [Google Scholar]
  • 6.Newbold KB, Eyles J, Birch S. Equity in health care: Methodological contributions to the analysis of hospital utilization within Canada. Soc Sci Med. 1995;40:1181. doi: 10.1016/0277-9536(94)00229-M. [DOI] [PubMed] [Google Scholar]
  • 7.Roos NP, Mustard CA. Variation in health and health care use by socioeconomic status in Winnipeg. 1997;75:89–111. doi: 10.1111/1468-0009.00045. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Mustard CA, Frohlich N. Socioeconomic status and the health of the population. Medical Care. 1995;33(12Suppl):DS43–54. doi: 10.1097/00005650-199512001-00007. [DOI] [PubMed] [Google Scholar]
  • 9.Jerrett M, Eyles J, Cole D. Socioeconomic and environmental covariates of premature mortality in Ontario. Soc Sci Med. 1998;47:33–49. doi: 10.1016/S0277-9536(98)00008-2. [DOI] [PubMed] [Google Scholar]
  • 10.Wilkins R, Sherman GJ, Best PA. Birth outcomes and infant mortality by income in urban Canada, 1986. Health Reports. 1991;3:7–31. [PubMed] [Google Scholar]
  • 11.Jarman B. Identification of underprivileged areas. Brit Med J Clin Res Ed. 1983;286:1705–9. doi: 10.1136/bmj.286.6379.1705. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Kahn HA, Sempos CT. Statistical Methods in Epidemiology. Monographs in Epidemiology and Biostatistics. Vol. 12. New York: Oxford University Press, 1989.
  • 13.Statistics Canada. Profile of Census DivisionsCensus Subdivisions — Part A. 1991 Census of Canada. Service number 846-031. Ottawa: Supply and Services Canada; 1992. [Google Scholar]
  • 14.Hospital Medical Records Institute. Resource Intensity Weights, RIW, Summary of Methodology. Don Mills, Ontario: HMRI; 1991. [Google Scholar]
  • 15.Womersley J, McCauley D. Tailoring health services to the needs of individual communities. J Epidemiol Community Health. 1987;41:190. doi: 10.1136/jech.41.3.190. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Andersen TF. Persistence of social and health problems in the welfare state: A Danish cohort experience from 1948 to 1979. Soc Sci Med. 1984;18:555. doi: 10.1016/0277-9536(84)90070-4. [DOI] [PubMed] [Google Scholar]
  • 17.Keskimaki I, Salinto M, Aro S. Socioeconomic equity in Finnish hospital care in relation to need. Soc Sci Med. 1995;41:425. doi: 10.1016/0277-9536(94)00339-U. [DOI] [PubMed] [Google Scholar]
  • 18.Romelsjo A, Kaplan GA, Cohen RD, et al. Protective factors and social risk factors for hospi-talization and mortality among young men. Am J Epidemiol. 1992;135:649. doi: 10.1093/oxfordjournals.aje.a116344. [DOI] [PubMed] [Google Scholar]
  • 19.McMahon LF, McLaughlin CG, Petroni GR, Tedeschi PJ. Small area analysis of hospital discharges for musculoskeletal diseases in Michigan: The influence of socioeconomic factors. Am J Med. 1991;91:173. doi: 10.1016/0002-9343(91)90011-L. [DOI] [PubMed] [Google Scholar]
  • 20.Billings J, Zeitel L, Lukomnik J, et al. Impact of socioeconomic status on hospital use in New York City. Health Affairs. 1993;12:162. doi: 10.1377/hlthaff.12.1.162. [DOI] [PubMed] [Google Scholar]
  • 21.Newacheck PW. Poverty and childhood chronic illness. Arch Pediatr Adolesc Med. 1994;148:1143. doi: 10.1001/archpedi.1994.02170110029005. [DOI] [PubMed] [Google Scholar]
  • 22.Gottlieb DJ, Beiser AS. O’Connor GT. Poverty, race, and medication use are correlates of asthma hospitalization rates. A small area analysis in Boston. Chest. 1995;108:28. doi: 10.1378/chest.108.1.28. [DOI] [PubMed] [Google Scholar]
  • 23.Morris RD, Munasinghe RL. Geographic variability in hospital admission rates for respiratory disease among the elderly in the United States. Chest. 1994;106:1172. doi: 10.1378/chest.106.4.1172. [DOI] [PubMed] [Google Scholar]
  • 24.Carr W, Zeitel L, Weiss K. Variations in asthma hospitalizations and deaths in New York City. Am J Public Health. 1992;82:59. doi: 10.2105/AJPH.82.1.59. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.McConnochie KM, Roghmann KJ, Liptak GS. Hospitalization for lower respiratory tract illness in infants: Variation in rates among counties in New York State and areas within Monroe County. J Pediatr. 1995;126:220. doi: 10.1016/S0022-3476(95)70548-1. [DOI] [PubMed] [Google Scholar]
  • 26.Halfon N, Newacheck PW. Childhood asthma and poverty: Differential impacts and utilization of health services. Pediatrics. 1993;91:56. [PubMed] [Google Scholar]
  • 27.Lynch JW, Kaplan GA, Salonen JT. Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse. Soc Sci Med. 1997;44:809–19. doi: 10.1016/S0277-9536(96)00191-8. [DOI] [PubMed] [Google Scholar]
  • 28.Lynch JW, Kaplan GA, Cohen RD, et al. Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction? Am J Epidemiol. 1996;144:934–42. doi: 10.1093/oxfordjournals.aje.a008863. [DOI] [PubMed] [Google Scholar]
  • 29.Diez-Roux AV. Bringing context back into epidemiology: Variables and fallacies in multilevel analysis. Am J Public Health. 1998;88:216–22. doi: 10.2105/AJPH.88.2.216. [DOI] [PMC free article] [PubMed] [Google Scholar]

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