Dataset Information

Neighborhood socioeconomic status and use of colonoscopy in an insured population--a retrospective cohort study.

ABSTRACT: Low-socioeconomic status (SES) is associated with a higher colorectal cancer (CRC) incidence and mortality. Screening with colonoscopy, the most commonly used test in the US, has been shown to reduce the risk of death from CRC. This study examined if, among insured persons receiving care in integrated healthcare delivery systems, differences exist in colonoscopy use according to neighborhood SES.We assembled a retrospective cohort of 100,566 men and women, 50-74 years old, who had been enrolled in one of three US health plans for ≥1 year on January 1, 2000. Subjects were followed until the date of first colonoscopy, date of disenrollment from the health plan, or December 31, 2007, whichever occurred first. We obtained data on colonoscopy use from administrative records. We defined screening colonoscopy as an examination that was not preceded by gastrointestinal conditions in the prior 6-month period. Neighborhood SES was measured using the percentage of households in each subject's census-tract with an income below 1999 federal poverty levels based on 2000 US census data. Analyses, adjusted for demographics and comorbidity index, were performed using Weibull regression models.The average age of the cohort was 60 years and 52.7% were female. During 449,738 person-years of follow-up, fewer subjects in the lowest SES quartile (Q1) compared to the highest quartile (Q4) had any colonoscopy (26.7% vs. 37.1%) or a screening colonoscopy (7.6% vs. 13.3%). In regression analyses, compared to Q4, subjects in Q1 were 16% (adjusted HR = 0.84, 95% CI: 0.80-0.88) less likely to undergo any colonoscopy and 30%(adjusted HR = 0.70, CI: 0.65-0.75) less likely to undergo a screening colonoscopy.People in lower-SES neighborhoods are less likely to undergo a colonoscopy, even among insured subjects receiving care in integrated healthcare systems. Removing health insurance barriers alone is unlikely to eliminate disparities in colonoscopy use.

SUBMITTER: Doubeni CA

PROVIDER: S-EPMC3342210 | biostudies-other | 2012

REPOSITORIES: biostudies-other

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Project description:BackgroundThe World Health Organization has recognized maternal mental illness as an emerging issue. Previous studies have indicated that maternal mental illness is associated with socioeconomic status (SES). However, there is a lack of research concerning the mental health of pregnant people with low SES in Ontario, Canada. In this study, we examined associations between mental health conditions during pregnancy and two SES indicators: the pregnant person's residential neighbourhood income and education level.MethodsA population-based retrospective cohort study was conducted, consisting of all singleton pregnancies resulting in stillbirths or live births in Ontario hospitals from April 1, 2012, to March 31, 2021. Data were linked from the BORN Information System database, Canadian Institute for Health Information Discharge Abstract Database, and Canadian Census. Poisson regression with robust error variance models was performed to estimate the relative risks of anxiety, depression, anxiety and/or depression, or any mental health condition during pregnancy, by SES indicator. We adjusted for maternal age, obesity status in pre-pregnancy, certain pre-existing maternal health conditions, substance use during pregnancy, race, and rural or urban residence.ResultsWithin the cohort (n = 1,202,292), 10.5% (126,076) and 8.1% (97,135) of pregnant individuals experienced anxiety and depression, respectively, and 15.8% (189,616) had at least one mental health condition during pregnancy. The trend test (p < 0.0001) showed a significant downward trend in the total rates of mental health conditions by increasing SES quintiles. Pregnant individuals in the lowest neighbourhood income quintile tended to have a higher risk of anxiety (aRR: 1.24, 95%CI: 1.22-1.27), depression (aRR: 1.56, 95%CI: 1.52-1.59), anxiety and/or depression (aRR: 1.13, 95%CI: 1.11-1.15), or any mental health condition (aRR: 1.18, 95%CI: 1.16-1.19). Similarly, pregnant people living in the lowest education level neighbourhoods had higher likelihoods of anxiety (aRR: 1.66, 95%CI: 1.62-1.69), depression (aRR: 2.09, 95%CI: 2.04-2.14), anxiety and/or depression (aRR: 1.42, 95%CI: 1.39-1.44), and any mental health condition (aRR: 1.41, 95%CI: 1.38-1.43).ConclusionsDespite a universal healthcare system, the variations in mental health prevalence and risk during pregnancy based on SES suggest health inequity in Ontario, Canada. Future studies are needed to examine the mechanisms of this health inequity to guide policy makers in reducing disparities in Ontario.

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