Health Inequities in Manitoba: Is the Socioeconomic Gap

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Chapter 6: Primary Care and Prevention 124 University of Manitoba This page edited May 18, 2011. Urban: • From T1 to T5, rates of hospitalizations due to tuberculosis dropped for U1, U2, and U3; it rose slightly for U4 and remained stable for U5. • Depending upon the measure used, the disparity between U1 and U5 remained similar or narrowed between the first and last time period for tuberculosis hospitalization rates. The rate ratio of U1 compared to U5 was 14.46 in the first time period and 9.43 in the last time period; this decrease is not statistically significantly different. The absolute difference gap in tuberculosis hospitalization rates comparing U1 to U5 decreased over the study period; 35.20 per 100,000 more tuberculosis hospitalizations in U1 compared to U5 in the first time period, and 19.19 more per 100,000 in the last time period, for a statistically significant decrease of 45%. Lorenz Curves: Rural over time: • In T1, 40.9% of tuberculosis hospitalizations were accounted for in the 20.0% of the rural population in the lowest neighbourhood income quintile group (R1), with the Gini coefficient of 0.260 indicating a statistically significant (and large) inequality. • In T5, 57.2% of the tuberculosis hospitalizations were accounted for in the 19.9% of the population in the lowest neighbourhood income quintile group (R1), with the Gini coefficient of 0.463 indicating a statistically significant (and large) inequality. • The Gini coefficient from T1 to T5 increased from 0.260 to 0.463, a statistically significant increase (p
Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing Over Time? This page edited May 18, 2011. • The disparity rate differences (DRDs) for the rural neighbourhood income quintiles are statistically increasing over time, while there was statistically significantly decreasing disparity over time in the urban neighbourhood income quintiles. The absolute differences between the lowest and highest neighbourhood income groups were similar across rural and urban quintiles for all time periods except the last time period, where the rate difference in rural areas was wider than in urban areas. What is this telling us? • The socioeconomic gap in rates of hospitalizations due to tuberculosis is very high in both rural and urban neighbourhood income quintiles in all time periods. • The socioeconomic gap in tuberculosis hospitalization rates is widening over time in rural Manitoba, according to all three measures. However, in urban areas, the socioeconomic gap is narrowing according to some measures, but staying similar according to other measures. • Although the rate ratio in tuberculosis hospitalization rates by neighbourhood income quintile groups was higher in urban compared to rural in the first time period, for all subsequent time periods the rate ratio was similar between rural and urban areas. On the other hand, the rate difference by neighbourhood income quintile groups was similar between rural and urban areas for all time periods except the last, when the gap was wider in rural compared to urban areas. • Over time, the rate ratio is similar in urban neighbourhood income groups, but is widening in rural neighbourhood income groups. The rate difference is narrowing over time in urban neighbourhood income quintile groups, but staying the same over time for the rural neighbourhood income quintile groups. Where to from here? • An examination of all the factors that lead to hospitalization for tuberculosis should be undertaken to understand where, along the pathway, success has been found in decreasing hospitalization rates in low neighbourhood income groups in urban areas. For example: a person is exposed and the tuberculosis becomes latent or active; they seek or do not seek prompt primary care; they are accurately diagnosed with appropriate medical tests; they are treated with appropriate medications to which their particular tuberculosis is sensitive; and, thorough contact tracing is done to limit the spread to other people. This is not an exhaustive list as things such as exposure also depend on factors such as housing quality, overcrowding, etc. • Investigation into the differences between rural and urban tuberculosis programs should be completed so the successes of the urban program could be applied to rural areas. Manitoba Centre for Health Policy 125
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HEALTH INEQUITIES IN MANITOBA: Is t
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About the Manitoba Centre For Healt
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Dr. Patricia Martens acknowledges t
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Key findings: High School Completio
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List of Figures Figure 1.1 Distribu
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Figure 4.27 Adjusted Lorenz Curve f
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Figure 6.15 Hospitalization Due to
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List of Tables Table E.1 Changes in
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Figure A3.6 Adjusted Lorenz Curve f
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Executive Summary Health status and
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(derived from Table E.1’s columns
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Table E.1: Continued Indicator RURA
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Table E.1: Continued Indicator RURA
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Table Table E.2: E.2: Is Is the the
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This page edited May 18, 2011. Tabl
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References Commission on Social Det
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Health Inequities in Manitoba: Is t
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Table 2.1: Neighbourhood Income Qui
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Table 2.3: Neighbourhood Table 2.3:
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Figure 3.2: Premature Mortality Rat
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Figure 3.10: Potential Years of Lif
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Cumulative Percent of Potential Yea
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Figure 3.18: Under Five Mortality R
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Figure 4.2: Teen Pregnancy Rates Ov
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Figure 4.10: High School Completion
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Figure 4.18: Dental Extraction Rate
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Table 9.1: Continued Indicator RURA
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Table 9.1: Continued Health Inequit
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Table A2.3: Crude Numbers of Mortal
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Table A2.5: Crude Numbers for High
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Table A2.7: Crude Numbers for Denta
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Table A2.11: Crude Numbers for Isch
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Table A2.13: Crude Numbers for Cont
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CONFIDENTIAL ‐‐ NOT FOR DISTRIB
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Table A2.17: Crude Numbers for Cumu
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Figure A3.2: High School Appendix C
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Health Inequities in Manitoba: Is the Socioeconomic Gap

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