Health Inequities in Manitoba: Is the Socioeconomic Gap

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Chapter 4: Child Health 64 University of Manitoba • Depending upon the measure used, the disparity between R1 and R5 remained similar or widened between the first time period T1 and the second time period T5 for hospital–based dental extraction rates. The rate ratio of R1 compared to R5 was 4.15 in the first time period and 6.45 in the last time period, but this change was not statistically significant. The absolute difference gap in dental extraction rates comparing R1 to R5 was 14.58 in T1 and 50.28 in T5, an increase of 245% which was statistically significant, and indicates an increase in inequality over time. Urban: • From T1 to T5, dental extraction rates increased only slightly for U4 and U5, almost doubled for U3 and U2, and more than doubled for U1. • 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 T5 for hospital–based dental extraction rates. The rate ratio of U1 compared to U5 was 7.79 in the first time period and 13.09 in the last time period; this increase of 68% in the rate ratio is not statistically significantly different. The absolute difference gap in dental extraction rates comparing U1 to U5 widened, going from 6.82 per 1,000 U1 compared to U5 in the first time period to 16.76 per 1,000 in the last time period for an increase of 146% in the difference, which was statistically significant. Lorenz Curves: Rural over time: • In T1, 53.5% of hospital–based dental extractions were accounted for in the 22.7% of the rural population of children up to age five in the lowest neighbourhood income quintile group (R1), with the Gini coefficient of 0.363 indicating a statistically significant inequality. • In T5, 53.6% of dental extractions occurred in the 26.0% of the population of children aged birth to five years in the lowest neighbourhood income quintile group (R1), with the Gini coefficient of 0.383 indicating a statistically significant inequality. • The Gini coefficient from T1 to T5 was not statistically significantly different, showing similar disparity over time. Urban over time: • In T1, 47.4% of hospital–based dental extractions occurred in the 21.6% of the urban population of children up to age five in the lowest neighbourhood income quintile group (U1), with the Gini coefficient of 0.356 indicating a statistically significant disparity. • In T8, 55.9% of dental extractions occurred in the 23.7% of the urban population in the lowest neighbourhood income quintile group (U1), with the Gini coefficient of 0.421 indicating a statistically significant disparity. • The Gini coefficient was not statistically significantly different from the first to the last time period (0.356 to 0.421, p=.053, NS), although the p–value indicates that this may be due to small numbers and may actually show a trend to an increase. However, there was similar inequality in urban children up to age five having dental extractions over that time period. Rural compared to urban in most recent time period: • In the most recent time period T5, there is no statistically significantly difference for Gini coefficient in urban compared to rural (0.421 vs. 0.383, p=0.064, NS), indicating a similar level of inequality in urban Manitoba for hospital–based dental extractions in children aged birth to five years. Because the p–value is so close to 0.05, this may indicate a trend towards greater urban inequality, but this is based upon small numbers.
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 hospital–based dental extraction rates in the lowest compared to the highest neighbourhood income group) are similar across time for both the rural and urban neighbourhood income quintiles. The disparity rate ratios of urban and rural neighbourhood income quintile groups are quite similar, with the tendency that urban DRRs tend to show higher disparity for most time periods (although not statistically significant). • The disparity rate differences (DRDs) are widening for both urban and rural neighbourhood income quintiles over time, with statistically significant differences comparing T5 to T1 in both groups. For every time period, the absolute differences between lowest and highest neighbourhood income quintile group are statistically significantly larger in rural compared to urban. In the last time period T5, the DRD for rural children was three times higher than that for urban children. What is this telling us? • The rate of hospital–based dental extractions for children up to five years of age is much higher in rural compared to urban areas. • There is a substantial socioeconomic gap in hospital–based dental extractions in both rural and urban areas, with children in R1, U1, and to a lesser extent R2. These quintiles have much higher rates of this procedure than children with higher socioeconomic status. • The socioeconomic gap in dental extractions for children from birth to five years is widening over time in rural and urban Manitoba, according to some measures but staying similar according to other indicators. Rate ratios remained similar, whereas rate differences increased in both rural and urban areas. • The rate ratio in dental extractions by neighbourhood income quintile groups is higher in urban compared to rural areas, whereas the rate difference is higher in rural areas. • The much higher rates of hospital–based dental extractions for children up to age five in low socioeconomic areas is both a good news and bad news story. The good news is that the children who need this procedure the most appear to be getting it, at much higher rates than their higher socioeconomic counterparts. The bad news is that this invasive procedure is an indication that children from lower socioeconomic status areas, particularly in rural Manitoba, have very poor dental health from a very early age. Where to from here? • There are inequalities in hospital–based dental extractions that indicate underlying inequities in dental health. In other words, the inequality in dental extraction rates is a reflection of need (and hence may be considered fair or equitable). That being said, if this indicator is thought of as a surrogate for underlying disparities in poor dental health, then it reflects a serious need for public health action. Efforts to improve early dental health in low socioeconomic areas, particularly in rural Manitoba, should be supported. • Linking this indicator with the breastfeeding indicator would be useful, as bottle feeding is a risk factor for dental decay (Mobley, 2009; Mohebbi, 2008). Hence public health strategies to decrease bottle feeding may be one approach to decreasing the inequality. • Linking this indicator with availability of services in rural areas (both preventive and treatment) is also important to know where to target additional resources. Manitoba Centre for Health Policy 65
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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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Figure 6.2: Continuity of Care Prev
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Figure 6.10: Hospitalization Due to
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Figure 7.2: Prevalence of Cumulativ
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Dementia Health Inequities in Manit
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Figure 7.10: Dementia Prevalence Ov
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Figure 7.18: Prevalence of Complete
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Reference Health Inequities in Mani
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Figure 8.2: Post-AMI Care: Beta-Blo
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Reference Health Inequities in Mani
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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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