Inequalities in paediatric hospitalisations for costly and prevalent conditions in Ontario, Canada: a population-based cohort study

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Lancet Regional Health-Americas Pub Date : 2025-05-01 Epub Date: 2025-03-19 DOI:10.1016/j.lana.2025.101056

Peter J. Gill , Thaksha Thavam , Jingqin Zhu , Cornelia M. Borkhoff , Patricia C. Parkin , Eyal Cohen , Teresa To , Sanjay Mahant

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Abstract

Background

Identifying inequalities is important for informing research, and policy efforts to reduce health disparities. This study measured the inequalities in hospitalisations for the costly and prevalent conditions in hospitalised children using association estimates.

Methods

Population-based cohort study using health administrative databases in Ontario, Canada between 2014 and 2019. The hospitalisation rate was determined for the costly and prevalent conditions in children. Hospitalisation inequalities by four equity stratifiers (material resources, rurality, sex, and immigrant status) were quantified using rate difference (RD), rate ratio (RR), and ratio of excess to total hospitalisation rate. Multivariable logistic regression analyses were also conducted.

Findings

In a population of 3·7 million children (median age 7·0 years, Interquartile range: 1·0–12·0), there were 612,597 hospitalisations. Large inequalities comparing children among least versus most resourced quintile was observed in low birth weight (RD: 1,823·3 hospitalisations per 100,000 children, 95% CI: 1,662·7, 1,983·9). Conditions with large inequalities comparing rural versus urban areas included low birth weight (RD: −1,833·2 hospitalisations per 100,000, 95% CI: −2,012·8, −1,653·6); and drug withdrawal syndrome in newborn (RR: 1·9, 95% CI: 1·7, 2·1; adjusted odds ratio (aOR): 1·4, 95% CI: 1·2, 1·5). Conditions with large inequalities comparing males versus females included low birth weight (RD: −888·3 hospitalisations per 100,000, 95% CI: −992·5, −784·02); and anorexia nervosa (RR: 0·08, 95% CI: 0·07, 0·10; aOR: 0·1, 95% CI: 0.1, 0.1). Conditions with large inequalities comparing non-refugee immigrants versus non-immigrants included major depressive disorder (RR: 2·8, 95% CI: 2·7, 2·9), and comparing refugees versus non-immigrants included drug withdrawal syndrome in newborn (RR: 0·09, 95% CI: 0·05, 0·15). Results from multivariable analyses were similar.

Interpretation

Newborn and mental health conditions had the largest inequalities in hospitalisations by the equity stratifiers. Findings from this study can be used to prioritise future health equity research to reduce health inequalities.

Funding

PSI Foundation.

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加拿大安大略省儿科住院治疗的不平等现象：一项基于人群的队列研究

确定不平等现象对于为研究和减少卫生差距的政策努力提供信息非常重要。本研究使用关联估计测量了住院儿童在昂贵和普遍条件下的住院不平等。方法利用加拿大安大略省2014 - 2019年卫生管理数据库进行基于人群的队列研究。住院率是根据儿童昂贵和普遍的情况确定的。采用比率差（rate difference， RD）、比率比（rate ratio， RR）和超额住院率与总住院率之比对四个公平分层因素（物质资源、农村性、性别和移民身份）的住院不平等进行量化。并进行多变量logistic回归分析。结果：在370万儿童（中位年龄为7.0岁，四分位数范围为1.0 - 12.0）中，有612597人住院。在低出生体重方面，资源最少的五分位数与资源最多的五分位数之间存在巨大的不平等（RD：每10万名儿童1,823.3例住院，95% CI: 1,662·7,1,983·9）。与城市地区相比，农村地区存在较大不平等的条件包括低出生体重（RD：每100,000人中有- 1,833.2人住院，95% CI: - 2,012.8, - 1,653.6）；新生儿药物戒断综合征(RR: 1.9, 95% CI: 1.7, 2.1；校正优势比（aOR）： 1.4, 95% CI: 1.2, 1.5)。男女差异较大的条件包括低出生体重（RD：每100,000人中有- 888·3人住院，95% CI: - 992·5,- 784·02）；神经性厌食症(RR: 0.08, 95% CI: 0.07, 0.10；aOR: 0.01, 95% CI: 0.1, 0.1)。非难民移民与非移民之间存在较大不平等的条件包括重度抑郁症（RR: 2.8, 95% CI: 2.7, 2.9），难民移民与非移民之间存在较大不平等的条件包括新生儿药物戒断综合征（RR: 0.09, 95% CI: 0.05, 0.15）。多变量分析结果相似。解释新生儿和精神健康状况在公平分层者住院方面存在最大的不平等。这项研究的结果可用于优先考虑未来的卫生公平研究，以减少卫生不平等。FundingPSI基础。

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

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0.00%

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期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.