Health Inequities in Manitoba: Is the Socioeconomic Gap

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Appendix 1: Glossary 196 University of Manitoba Depression The proportion of residents aged 10 or older diagnosed with depression over a five–year period, by any of the following: • one or more hospitalizations with a diagnosis for depressive disorder, affective psychoses, neurotic depression or adjustment reaction, ICD–9–CM codes 296.2–296.8, 300.4, 309, 311; ICD–10–CA codes F31, F32, F33, F34.1, F38.0, F38.1, F41.2, F43.1, F43.2, F43.8, F53.0, F93.0 • one or more physician visits with a diagnosis for depressive disorder, affective psychoses or adjustment reaction, ICD–9–CM codes 296, 309, 311 • one or more hospitalizations with a diagnosis for anxiety disorders, ICD–9–CM code 300; ICD–10–CA codes F32.0, F34.1, F40, F41, F42, F44, F45.0, F451, F452, F48, F68.0, F99 • one or more physician visits with a diagnosis for anxiety disorders, ICD–9–CM code 300 Diabetes Diabetes mellitus is a chronic condition in which the pancreas no longer produces enough insulin (type 1 diabetes) or when cells stop responding to the insulin that is produced (type 2 diabetes), so that glucose in the blood cannot be absorbed into the cells of the body. The most common endocrine disorder, diabetes mellitus affects many organs and body functions, especially those involved in metabolism, and can cause serious health complications including renal failure, heart disease, stroke, and blindness. Symptoms include frequent urination, fatigue, excessive thirst, and hunger. Also called insulin–dependent diabetes, type 1 diabetes begins most commonly in childhood or adolescence and is controlled by regular insulin injections. The more common form of diabetes, type 2, can usually be controlled with diet and oral medication. Another form of diabetes called gestational diabetes can develop during pregnancy and generally resolves after the baby is delivered. In this report, diabetes prevalence was calculated as the proportion of residents aged 19 and older diagnosed with diabetes in a three–year period, by at least two physician visits or one hospitalization with a diagnosis of diabetes (ICD–9–CM code 250; ICD–10–CA codes E10–E14). Because data on prescription medications is not available for all time periods in this analysis, prescription medication use to treat diabetes was not included in the calculation of diabetes prevalence. The definition excludes gestational diabetes. Disparity Rate Difference (DRD) Disparity Rate Difference (DRD) is one measure of a socioeconomic gap, subtracting the rate of the lowest neighbourhood income group from the rate of the highest neighbourhood income group (i.e., R1 minus R5 or U1 minus U5). This is sometimes referred to in the text as the “rate difference”. There is also a statistical test for the time comparison of the DRD, measuring the change in the DRD or rate difference from the first to the last time period. This is given as a ratio of DRDs from the last time period to the first time period. The p–value associated with this is also provided. DRDs can be thought of as a way to express how many “more” (or “less”) events occur in the lowest neighbourhood income quintile group compared to the highest. Disparity Rate Ratio (DRR) Disparity Rate Ratio (DRR) is one measure of a socioeconomic gap, dividing the rate of the lowest neighbourhood income group by the rate of the highest neighbourhood income group (i.e., R1/R5 or U1/U5). This is sometimes referred to in the text as the “rate ratio”. There is also a statistical test for the time comparison of the DRR, measuring the change in the DRR or rate ratio from the first to the last time period. This is given as a ratio of DRRs from the last time period to the first time period. We also supply its 95% confidence interval and the p–value. DRRs can be thought of as a way to express the relative increase or decrease in inequality between the lowest and highest neighbourhood income quintile groups over time.
Health Inequities in Manitoba: Is the Socioeconomic Gap in Health Widening or Narrowing Over Time? Dissemination Area (DA) “A small, relatively stable geographic unit composed of one or more blocks. It is the smallest standard geographic area for which all census data are disseminated. DAs cover all the territory of Canada.” As of 2001, the DA replaces the enumeration area as a basic unit for dissemination (Statistics Canada, 2007). Drug Programs Information Network (DPIN) DPIN is an electronic, on–line, point–of–sale prescription drug database. It links all community pharmacies (but not pharmacies in hospitals or nursing homes/personal care homes) and captures information about all Manitoba residents, including most prescriptions dispensed to status Indians. DPIN contains information such as unique patient identification, medication history, over–the–counter medication history, new drug prescribed, date dispensed, and unique pharmacy identification number. DPIN is maintained by Manitoba Health. Fiscal Year The fiscal year starts on April 1 and ends the following March 31. For example, the 2003/04 fiscal year would be April 1, 2003 to March 31, 2004, inclusive. General Practitioner/Family Practitioner (GP/FP) A physician who operates a general or family practice and is not certified in another specialty in Manitoba. Gini Coefficient The Gini coefficient is a measure of disparity in a population. It is the ratio of the area between the line of equality and the Lorenz curve divided by the total area under the line of equality. The calculated Gini coefficient can take on a value from 0 to 1. A Gini coefficient equal to 0 indicates that there is zero disparity in the population such as in the case where there is perfect equality. A Gini coefficient equal to one indicates that there is perfect inequality in the population. A general rule is that the closer the Gini is to zero the less disparity there is between the neighbourhood income quintile groups and hence the overall population. A formula for calculating a Gini coefficient is as follows (adapted from Gini, 1955): GINI = abs(A–B) Where A = sum[X(i) * Y(i+1)] B = sum[X(i+1) * Y(i)] X = proportion of income in the population Y = proportion of events in the population X(i+1) = lag(X(i)) Y(i+1) = lag(Y(i)) Manitoba Centre for Health Policy 197
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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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Figure 5.2: Diabetes Prevalence Ove
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Figure 5.10: Amputations Among Figu
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Figure 5.18: Ischemic Heart Disease
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Figure 5.26: Multiple Sclerosis Pre
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References: Health Inequities in Ma
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Figure 6.2: Continuity of Care Prev
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Figure 6.10: Hospitalization Due to
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CONFIDENTIAL -- NOT FOR DISTRIBUTIO
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Figure 7.2: Prevalence of Cumulativ
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Page 179 and 180: Dementia Health Inequities in Manit
Page 183 and 184: Figure 7.10: Dementia Prevalence Ov
Page 191 and 192: Figure 7.18: Prevalence of Complete
Page 195 and 196: Reference Health Inequities in Mani
Page 201 and 202: Figure 8.2: Post-AMI Care: Beta-Blo
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Page 209 and 210: Table 9.1: Continued Indicator RURA
Page 211 and 212: Table 9.1: Continued Health Inequit
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Page 243 and 244: Table A2.3: Crude Numbers of Mortal
Page 245 and 246: Table A2.5: Crude Numbers for High
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Page 251 and 252: Table A2.11: Crude Numbers for Isch
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Page 257 and 258: Table A2.17: Crude Numbers for Cumu
Page 263 and 264: Figure A3.2: High School Appendix C
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Health Inequities in Manitoba: Is the Socioeconomic Gap

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