Health Inequities in Manitoba: Is the Socioeconomic Gap

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Chapter 7: Mental Health 148 University of Manitoba • The disparity between R1 and R5 did not change over time. The rate ratio of R1 compared to R5 was 1.08 in the first time period and 1.03 in the last time period, for a non–statistically significant decrease. The absolute difference gap in dementia rates comparing R1 to R5 was also not statistically significant, going from 0.48 in T1 to 0.23 in T5. Urban: • Comparing T1 to T5, dementia prevalence of all urban neighbourhood income quintile groups increased over time. Only in U3 was the increase steady across all time periods; for all other urban neighbourhood income quintiles, there was one (U1 and U5) or two (U2 and U4) periods of decrease, with an overall increase over time. • The disparity between U1 and U5 was stable by one measure and increased by another measure. The rate ratio of U1 compared to U5 was 1.25 in the first time period and 1.28 in the last time period, but this increase was not statistically significant. The absolute difference gap in dementia prevalence comparing U1 to U5 statistically significantly increased by 96% over time, from 1.39 more persons with dementia per 100 residents aged 55 and older in U1 compared to U5 in the first time period (1984/85–1988/89) to 2.73 more persons with dementia per 100 residents in the last time period (2004/05–2008/09). Lorenz Curves: Rural over time: • In T1, 20.0% of persons with dementia were accounted for in 19.7% of the population in the lowest neighbourhood income quintile group R1, with the Gini coefficient of 0.010 indicating no disparity. • In T5, 17.0% of persons with dementia were accounted for in 16.9% of the population in the lowest neighbourhood income quintile group R1, with the Gini coefficient of 0.003 indicating no disparity across rural neighbourhood income quintile groups. • The Gini coefficient decreased from the first to the last time period, but the decrease was not statistically significant, which indicates no change in inequality over that time period. Urban over time: • In T1, 26.7% of persons with dementia were accounted for in 23.1% of the population in the lowest neighbourhood income quintile group U1, with the Gini coefficient of 0.050 indicating a statistically significant disparity. • In T5, 26.1% of persons with dementia were accounted for in 20.4% of the population in the lowest neighbourhood income quintile group U1, with the Gini coefficient of 0.056 indicating a statistically significant disparity. • The Gini coefficient increased slightly from the first to the last time period, but the change was not statistically significant, which indicates no change in inequality over that time period. Rural compared to urban in most recent time period: • In the most recent time period T5, there is a statistically significantly higher Gini coefficient in urban compared to rural (0.003 vs. 0.056, p
Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing Over Time? • The disparity rate differences (i.e., the absolute difference of dementia rates between the lowest and highest neighbourhood income group) are increasing in urban neighbourhood income areas over time but staying stable in rural areas. In T1 and T2, the absolute differences are similar in rural and urban; but in the last three time periods, the absolute differences are higher in urban compared to rural areas. What is this telling us? • There is no socioeconomic gap in the prevalence of dementia for residents aged 55 and older in rural areas. On the other hand, there is a socioeconomic gap in dementia rates in urban areas. • By all measures, the lack of a socioeconomic gap in dementia in rural areas remained stable throughout the study period. • The socioeconomic gap in dementia in urban areas increased by one measure (disparity rate differences) but remained stable by other measures (disparity rate ratios and Gini coefficients). • By most measures (disparity rate differences and Gini coefficients), the socioeconomic gap is larger in urban than in rural Manitoba. • All neighbourhood income groups in both rural and urban Manitoba show increasing dementia prevalence over time. • The NF group in the last time period T5 has a dementia prevalence of 68%, indicative of the institutionalized population. For further information about the NF group, see Chapter 9. Where to from here? • The difference in disparity patterns in rural and urban areas suggests that the pattern in urban areas may be due to downward mobility of urban Manitobans with dementia. Programs supporting urban residents with dementia and their family members should include supports for helping those with dementia remain in their homes. • Dementia rates have increased in rural and urban Manitoba in 20 years. Programs focussed on assisting those with dementia and their family members should be supported. • The socioeconomic gap in dementia prevalence is fairly small, so programs providing support to those with dementia and their families’ members should be universal rather than targeted. Manitoba Centre for Health Policy 149
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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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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 4.18: 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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Figure 5.2: Diabetes Prevalence Ove
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Figure 5.10: Amputations Among Figu
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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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