Health Inequities in Manitoba: Is the Socioeconomic Gap

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Chapter 6: Primary Care and Prevention 132 University of Manitoba • The disparity in Pap test rates between R1 and R5 increased over time between the first and last time period. The rate ratio of R1 compared to R5 was 0.82 in the first time period and 0.72 in the last time period, a statistically significant widening of the gap mainly due to the decrease in Pap test rates in R1. The absolute difference gap in Pap test rates comparing R1 to R5 was 12.03 less Pap tests per 100 women in T1 and 18.37 less in T8, showing a statistically significant decrease in Pap testing in R1 compared to R5 over time. Urban: • From T1 to T8, Pap test rates remained relatively stable over time with slight increases in U2 to U5, but slight decreases in U1, so the gap widens. • Depending upon the measure used, the disparity between U1 and U5 remained similar or widened between the first time period T1 and the second time period T8 for Pap test rates. The rate ratio of U1 compared to U5 was 0.84 in the first time period and 0.80 in the last time period; this small increase of 4% in the rate ratio is not statistically significantly different. The absolute difference gap in Pap test rates comparing U1 to U5 widened; 11.55 per 100 less Pap tests in U1 compared to U5 in the first time period and 14.62 less per 100 in the last time period, for a statistically significant increase in the difference. Lorenz Curves: Rural over time: • In T1, 16.5% of Pap tests were accounted for in the 18.7% of the rural population of women aged 18–69 in the lowest neighbourhood income quintile group (R1), with the Gini coefficient of 0.035 indicating a statistically significant (although relatively small) inequality. • In T8, only 14.6% of Pap tests were accounted for in the 18.3% of the population of women aged 18–69 in the lowest neighbourhood income quintile group (R1), with the Gini coefficient of 0.059 indicating a statistically significant inequality. • The Gini coefficient from T1 to T8 increased from 0.035 to 0.059 (p
Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing Over Time? Disparity measures over time by rural and urban: • The disparity rate ratios (DRRs) (i.e., the ratio of Pap test rates in the lowest compared to the highest neighbourhood income group) are similar across time for the urban neighbourhood income quintiles, but the rural neighbourhood income quintiles show statistically significantly increasing disparity over time (i.e., the ratios are below 1 and decreasing). The disparity rate ratios of urban and rural neighbourhood income quintile groups are quite similar, with the tendency that rural DRRs tend to show higher disparity for most time periods (although not statistically significant in most time periods). • The disparity rate differences (DRDs) are widening for both urban and rural neighbourhood income quintiles over time, with statistically significant differences comparing T8 to T1 in both groups. However, for every time period except T4 (mid–1990s), the absolute differences between lowest and highest neighbourhood income quintile group are statistically significantly larger (i.e., more negative) in rural compared to urban. What is this telling us? • The socioeconomic gap in Pap test rates for women aged 18–69 is widening over time in rural Manitoba, according to all measures. However, in urban areas, the socioeconomic gap is possibly widening according to some indicators, but staying similar according to other indicators. • The rate ratio in Pap test rates by neighbourhood income quintile groups is similar in rural and urban in some time periods and higher in rural for other time periods. Over time, the rate ratio is staying similar in urban neighbourhood income groups, but is widening in rural neighbourhood income groups. The rate difference is increasing over time in both urban and rural neighbourhood income quintile groups; but for most time periods, the rate difference in Pap test rates is statistically significantly larger in the rural groups. • Most neighbourhood income groups in both rural and urban Manitoba show similar or decreasing Pap test rates among women aged 18–69 over time. R1 and R2 patterns show the greatest decrease over time, from 54.1% in T1 to 48.1% in T8 for R1 and 61.1% to 56.1% in the same time periods for R2. All other neighbourhood income quintile groups show either smaller drops of 1–2% or similar or increasing rates from T1 to T8. • The largest socioeconomic gap in Pap test rates for women aged 18–69 occur in the most recent time period T8 (2005/06–2007/08) for both urban and rural Manitoba. However, the inequality in Pap tests is relatively small (i.e., the bend in the Lorenz curve is close to equality) compared to several other indicators in this report. For 19.1% of the population of women aged 18–69 in the lowest neighbourhood income quintile R1 in rural, they account for 16.7% of the Pap tests. For 18.3% of the population in U1, they account for 14.6% of the Pap tests. Where to from here? • There are inequities in Pap test rates for women aged 18–69 by neighbourhood income groups, especially in rural Manitoba. These are increasing over time according to several disparity measures. However, all Pap test rates in all neighbourhood income quintile groups appear to have changed very little or slightly decreased from the first to the last time period. This would indicate the need for a universal screening program to increase rates across all socioeconomic groups, with possible targeted interventions especially for women in the lowest rural neighbourhood income quintiles. Manitoba Centre for Health Policy 133
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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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Figure 4.26: Breastfeeding Initiati
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References: Health Inequities in Ma
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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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