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Accessibility to health care facilities in Montreal Island: an application of relative accessibility indicators from the perspective of senior and non-senior residents.

https://arctichealth.org/en/permalink/ahliterature139831
Source
Int J Health Geogr. 2010;9:52
Publication Type
Article
Date
2010
Author
Antonio Paez
Ruben G Mercado
Steven Farber
Catherine Morency
Matthew Roorda
Author Affiliation
School of Geography and Earth Sciences, McMaster University, Hamilton Ontario, Canada. paezha@mcmaster.ca
Source
Int J Health Geogr. 2010;9:52
Date
2010
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Health Services Accessibility - statistics & numerical data
Humans
Middle Aged
Mobility Limitation
Quebec
Regression Analysis
Residence Characteristics
Socioeconomic Factors
Transportation - statistics & numerical data
Young Adult
Abstract
Geographical access to health care facilities is known to influence health services usage. As societies age, accessibility to health care becomes an increasingly acute public health concern. It is known that seniors tend to have lower mobility levels, and it is possible that this may negatively affect their ability to reach facilities and services. Therefore, it becomes important to examine the mobility situation of seniors vis-a-vis the spatial distribution of health care facilities, to identify areas where accessibility is low and interventions may be required.
Accessibility is implemented using a cumulative opportunities measure. Instead of assuming a fixed bandwidth (i.e. a distance threshold) for measuring accessibility, in this paper the bandwidth is defined using model-based estimates of average trip length. Average trip length is an all-purpose indicator of individual mobility and geographical reach. Adoption of a spatial modelling approach allows us to tailor these estimates of travel behaviour to specific locations and person profiles. Replacing a fixed bandwidth with these estimates permits us to calculate customized location- and person-based accessibility measures that allow inter-personal as well as geographical comparisons.
The case study is Montreal Island. Geo-coded travel behaviour data, specifically average trip length, and relevant traveller's attributes are obtained from the Montreal Household Travel Survey. These data are complemented with information from the Census. Health care facilities, also geo-coded, are extracted from a comprehensive business point database. Health care facilities are selected based on Standard Industrial Classification codes 8011-21 (Medical Doctors and Dentists).
Model-based estimates of average trip length show that travel behaviour varies widely across space. With the exception of seniors in the downtown area, older residents of Montreal Island tend to be significantly less mobile than people of other age cohorts. The combination of average trip length estimates with the spatial distribution of health care facilities indicates that despite being more mobile, suburban residents tend to have lower levels of accessibility compared to central city residents. The effect is more marked for seniors. Furthermore, the results indicate that accessibility calculated using a fixed bandwidth would produce patterns of exposure to health care facilities that would be difficult to achieve for suburban seniors given actual mobility patterns.
The analysis shows large disparities in accessibility between seniors and non-seniors, between urban and suburban seniors, and between vehicle owning and non-owning seniors. This research was concerned with potential accessibility levels. Follow up research could consider the results reported here to select case studies of actual access and usage of health care facilities, and related health outcomes.
Notes
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PubMed ID
20973969 View in PubMed
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Neighborhood social inequalities in road traffic injuries: the influence of traffic volume and road design.

https://arctichealth.org/en/permalink/ahliterature125107
Source
Am J Public Health. 2012 Jun;102(6):1112-9
Publication Type
Article
Date
Jun-2012
Author
Patrick Morency
Lise Gauvin
Céline Plante
Michel Fournier
Catherine Morency
Author Affiliation
Direction de santé publique de Montréal, Montréal, Québec, Canada. pmorency@santepub-mtl.qc.ca
Source
Am J Public Health. 2012 Jun;102(6):1112-9
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Accidents, Traffic - statistics & numerical data
Automobiles - statistics & numerical data
Environment Design
Facility Design and Construction
Humans
Quebec
Residence Characteristics
Socioeconomic Factors
Urban Population
Wounds and Injuries - epidemiology
Abstract
We examined the extent to which differential traffic volume and road geometry can explain social inequalities in pedestrian, cyclist, and motor vehicle occupant injuries across wealthy and poor urban areas.
We performed a multilevel observational study of all road users injured over 5 years (n=19,568) at intersections (n=17,498) in a large urban area (Island of Montreal, Canada). We considered intersection-level (traffic estimates, major roads, number of legs) and area-level (population density, commuting travel modes, household income) characteristics in multilevel Poisson regressions that nested intersections in 506 census tracts.
There were significantly more injured pedestrians, cyclists, and motor vehicle occupants at intersections in the poorest than in the richest areas. Controlling for traffic volume, intersection geometry, and pedestrian and cyclist volumes greatly attenuated the event rate ratios between intersections in the poorest and richest areas for injured pedestrians (-70%), cyclists (-44%), and motor vehicle occupants (-44%).
Roadway environment can explain a substantial portion of the excess rate of road traffic injuries in the poorest urban areas.
Notes
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PubMed ID
22515869 View in PubMed
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