Health Inequities in Manitoba: Is the Socioeconomic Gap

Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing Over Time?
Rural compared to urban in most recent time period:
• In the most recent time period T12, the Gini coefficient for rural neighbourhood income quintiles
was statistically significantly higher than for urban neighbourhood income quintiles, indicating a
greater level of inequality in rural compared to urban Manitoba for continuity of care.
Disparity measures over time by rural and urban:
• The disparity rate ratios (i.e., the ratio of the prevalence of continuity of care in the lowest compared
to the highest neighbourhood income group) are all below 1.00, indicating less continuity of care
in the lowest compared to the highest neighbourhood income quintiles. The disparity rate ratios
remained stable over time for both rural and urban Manitoba. For most of the time periods, there
was no difference in the ratios between rural and urban, although for T6–T8 and T11 the ratios were
greater (further from 1.00) in rural compared to urban areas.
• The disparity rate differences (DRD, i.e., the absolute difference of the prevalence of continuity
of care between the lowest and highest neighbourhood income group) show an uneven pattern
over time for both rural and urban areas. In rural areas, there was a significant increase in absolute
disparity (shown by numbers moving further away from 0.0); but in urban areas, the increase was not
statistically significant. For all time periods, the absolute differences were greater in rural compared
to urban areas (shown by DRDs further away from 0.0).
What is this telling us?
• By some measures, the socioeconomic gap in the prevalence of continuity of care is widening over
time for rural Manitobans, whereas for other measures the prevalence remains stable over time.
• By all measures, the socioeconomic gap in the prevalence of continuity of care is stable over time for
urban Manitobans.
• By some, but not all, measures, the socioeconomic gap is greater in rural compared in urban
Manitoba.
• The socioeconomic gap for continuity of care is not very wide is rural areas and is even narrower in
urban areas.
• The largest socioeconomic gap in prevalence of continuity of care is seen in the last time period for
rural Manitoba.
Where to from here?
• Absolute differences in continuity of care, as measured by the disparity rate differences (DRDs),
appear to be growing in rural Manitoba, even though the relative rates appear stable. Although
access to physicians is universal across the province, there may be barriers to accessing care, such
as distance to physician and lack of transportation in the lower income rural areas. Efforts should be
made to reduce barriers to access, particularly in these areas.
• The disparity in the prevalence of continuity of care is relatively small in both rural and urban areas.
However, the overall decrease in continuity of care in Manitoba is of concern and strategies to
increase continuity should be implemented, ensuring that disparities do not increase as a result of
these efforts.
Manitoba Centre for Health Policy 117