Health Inequities in Manitoba: Is the Socioeconomic Gap

Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing Over Time?
• In T4, 24.3% of the post-AMI patients dispensed a beta-blocker were accounted for in the 25.0% of
the population in U1, for a non-statistically significant Gini coefficient of 0.005. There was also no
evidence of disparity in urban areas as demonstrated by the Gini coefficient and the Lorenz curve.
• From T1 to T4, there was no statistically significant difference in inequality over time (p=0.034,
NS), and both time periods displayed non-statistically significant Gini coefficients (indicating no
inequality was evident in the quality of care received).
Rural compared to urban in most recent time period:
• In the most recent time period T4, there is no statistically significant difference in Gini coefficients in
rural compared to urban (0.018 vs. 0.005, p=0.55, NS). Both Gini coefficients were also not statistically
significantly different than 0. This indicates that there are similar levels of equity for post-AMI
patients receiving beta-blockers in rural and urban Manitoba and that these levels approximate the
line of equality.
Disparity measures over time by rural and urban:
• The disparity rate ratios (i.e., the ratio of those post-AMI patients who were dispensed a beta-blocker
in the lowest compared to the highest neighbourhood income) have remained stable throughout
the observation period T1 to T4 in both the urban and rural regions.
• The disparity rate differences (i.e., the absolute difference in the proportion of post-AMI patients who
were dispensed a beta-blocker in the lowest compared to the highest neighbourhood income) have
similarly remained stable over time with little evidence of disparity. However, in the rural region, the
absolute differences are consistently greater than in urban indicating a larger, albeit statistically nonsignificant,
rate difference between the lowest and highest neighbourhood income groups.
What is this telling us?
• Over the time period from 1996/97-1998/99 to 2005/06-2007/08, there is a continued upward trend
of the percentage of post-AMI patients receiving a beta-blocker prescription within four months of
their AMI. This indicates increasing quality of care across all neighbourhood income quintiles, both in
rural and urban Manitoba.
• Most indicators of disparity are showing that there is little inequality in this indicator. The exceptions
also show improvement: urban DRDs (disparity rate differences) show a decreasing inequality
between U1 and U5 over time and the rural Gini coefficient at T1 (very small but statistically
significant) showed no inequality in the latest time period T4.
• This indicator shows remarkable equity in pharmaceutical prescribing patterns for post-AMI patients,
with no statistically significant differences between neighbourhood income groupings in either rural
or urban quintiles in the latest time period T4.
Where to from here?
• Post-AMI patients in Manitoba are experiencing similar beta-blocker prescribing patterns no matter
what their socioeconomic group, and no matter where they live (rural or urban). As well, there is no
evidence of disparity, meaning that the percentage of the population having an AMI in each quintile
has a similar percentage of post-AMI patients receiving beta-blockers. Therefore, it would indicate
that no intervention is required to ensure equity, i.e., fair treatment post-AMI. That being said, the
lower income quintile groups have a higher incidence rate of AMIs (see Fransoo et al. 2009).
Manitoba Centre for Health Policy 167