The purpose of this study was to examine differences in adequacy of prenatal care and incidence of low birthweight between low-income women with Medicaid in Washington State and low-income women with Canadian provincial health insurance in British Columbia.
A population-based cross-sectional study was done by using linked birth certificates and claims data.
Overall, the adjusted odds ratio for inadequate prenatal care in Washington (comparing women with Medicaid with those with private insurance) was 3.2. However, the risk varied by time of Medicaid enrollment relative to pregnancy (2.0, 1.0, 2.7, 6.3; for women who enrolled prior to pregnancy, during the first trimester, during the second trimester, or during the third trimester, respectively). In British Columbia, the adjusted odds ratio for inadequate care (comparing women receiving a health premium subsidy with those receiving no subsidy) was 1.5 for women receiving a 100% subsidy and 1.2 for women receiving a 95% subsidy. The risk for low birthweight followed a similar trend in both regions, but there was no association with enrollment period in Washington.
Overall, the risk for inadequate prenatal care among poor women was much greater in Washington than in British Columbia. Most of the difference was due to Washington women's delayed enrollment in Medicaid. In both regions, the poor were at similar risk for low birthweight relative to their more affluent counterparts.
Cites: Health Serv Res. 1988 Aug;23(3):359-803403275
Cites: Am J Prev Med. 1989 May-Jun;5(3):157-632663051
Cites: Health Care Financ Rev. 1989 Summer;10(4):1-1510313273
Cites: JAMA. 1990 Nov 7;264(17):2219-232214099
Cites: Public Health Rep. 1990 Sep-Oct;105(5):533-52120734
Cites: Health Aff (Millwood). 1990 Winter;9(4):91-1112289763
Cites: J Health Polit Policy Law. 1987 Summer;12(2):221-353302000
The objectives of this study were as follows: (1) to compare the magnitude of the association between socioeconomic status (SES) and cancer survival in the Canadian province of Ontario with that in the United States (U.S.), and (2) to compare cancer survival in communities with similar SES in Ontario and in the U.S.
The Ontario Cancer Registry provided information about all cases of invasive cancer diagnosed in Ontario from 1987 to 1992, and the Surveillance, Epidemiology and End Results Registry (SEER) provided information about all cases diagnosed in the SEER regions of the U.S. during the same time period. Census data provided information about SES at the community level. The product-limit method was used to describe cause-specific survival. Cox proportional hazards models were used to describe the association between SES and the risk of death from cancer.
There were significant associations between SES and survival for most cancer sites in both the U.S. and Ontario, but the magnitude of the association was usually larger in the U.S. In the poorest communities, there were significant survival advantages in favor of cancer patients in Ontario for many disease groups, including cancers of the lung, head and neck region, cervix, and uterus. However, in upper- and middle-income communities, there were significant survival advantages in favor of the U.S. for all cases combined and for several individual diseases, including cancers of the breast, colon and rectum, prostate, and bladder.
The association between SES and cancer survival is weaker in Ontario than it is in the U.S. This is due to a combination of better survival among patients in the poorest communities and worse survival among patients in the wealthier communities of Ontario relative to those in the U.S.
Better Beginnings, Better Futures is a 25-year primary prevention policy research demonstration project. Its major purpose is to assess the extent to which community-based primary prevention programs can be effective in preventing emotional, behavioural, physical and cognitive problems in children from economically disadvantaged communities. The project grew out of a number of primary prevention initiatives introduced by the Ontario Ministry of Community and Social Services (MCSS) since the late 1970s. Eleven sites, four of them located on native reserves, received funding in January, 1991 to establish programs in their communities. From the beginning, a qualitative, naturalistic research approach has been utilized to document and understand the ways in which the programs have developed in the various Better Beginnings communities.
To assess how the exclusion of the economically inactive affects levels and trends in social class differences in mortality among men and women at different durations of follow-up.
Records of the 1970, 1975, 1980 and 1985 censuses on Finnish men and women aged 35-64 linked with records of all deaths during 1971-1990.
Exclusion of the economically inactive population underestimates the class differences in the total population by about 25% among men and 60% among women. The bias does not disappear if the first 5 years of follow-up are excluded and the bias can lead to erroneous conclusions about the trends in social class differences in mortality.
Analyses based on the economically active population may lead to significant underestimation of social class differences in mortality, introduce biases in international comparison and may only partially capture the causal mechanisms underlying these mortality differences. Our results further show that although the bias diminishes during the follow-up, it is by no means eliminated after the first 5 years. The underestimation of social class differences in mortality created by the exclusion of the inactive should be more widely recognized and more accurate data on previous occupations should be collected.
Canada's fiscal policies are damaging the health of Canadians, two physicians told a conference that examined globalization's impact on the country. Near-record unemployment levels and the recent recession have forced 41% of families in which the parents are 30 or younger to live below the poverty level; more than 21% of Canadian children are also considered to live in poverty. The impact tight fiscal policies have on health and well-being are enormous, say the dean of medicine at the University of Western Ontario and the chair of the Canadian Institute of Child Health.
It is possible to reduce rates of school dropout, teenage pregnancy, arrests for violent crime, and long term dependence on welfare. Programs that have improved outcomes among children in disadvantaged families provide access to an array of services cross professional and bureaucratic boundaries, emphasize relationships of trust and respect, are deeply rooted in the community, are family focused, and recognize the distinctive needs of those most at risk. If health, mental health, social service and education programs with these attributes are to reach the large numbers who need them, the systems within which these programs operate must be restructured.
This paper presents the results of an epidemiologic study that compares and contrasts psychosocial characteristics of parents and family units of children with chronic illness or physical disability (chronic health problems) with those of healthy children. Data were derived from the Ontario Child Health Study of 1869 randomly selected families, with 3294 children aged 4 to 16 years. In the absence of significant differences between parents and families of children with chronic illness alone and those with physical disability, these groups were combined for analysis, for which odds ratios (OR) or t tests were used. Significant positive findings included increased rates of parental treatment for "nerves" (mothers' OR = 2.1, fathers' OR = 1.9) and increased maternal negative affect scores (Bradburn Affect Balance Scale) (P less than .001) among parents of children with chronic health problems. Important negative findings (95% confidence interval of the OR included 1) included no increase in single-parent families (OR = 1.2), social isolation (OR = 1.0), or alcohol problems (OR = 1.2) among parents of children with chronic health problems. Categorically defined family dysfunction did not differ between the two groups (OR = 1.1). These data contrast with several clinic-based studies and suggest that, in a widely generalizable population survey, families of children with chronic health problems including physical disability do not suffer a marked excess of dysfunction, although some indicators of individual parent psychosocial problems were modestly elevated.(ABSTRACT TRUNCATED AT 250 WORDS)