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Published on: September 27, 2024
Socioeconomic status and utilization of amblyopia services at a tertiary pediatric hospital in Canada
Abhishek Sharma1, Agnes M F Wong2, Linda Colpa1
1Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ont.
Insights
Children from lower socioeconomic backgrounds, especially those living farther from the hospital, are less likely to use amblyopia services at a major pediatric center in Canada. This indicates an inequality in healthcare access despite a universal system.
Area of Science:
- Ophthalmology
- Public Health
- Health Services Research
Background:
- Amblyopia, a leading cause of visual impairment in children, requires timely intervention for effective treatment.
- Equitable access to specialized pediatric eye care services is crucial for optimal patient outcomes.
- Socioeconomic status (SES) can influence healthcare-seeking behaviors and access to services.
Purpose of the Study:
- To determine if socioeconomic status impacts the utilization of amblyopia services at The Hospital for Sick Children (SickKids), a Canadian pediatric tertiary care center.
- To assess the distribution of amblyopia patients across different income quintiles and compare it to expected utilization rates.
Main Methods:
- A retrospective, cross-sectional study analyzed medical records of children under 7 years diagnosed with amblyopia between 2007 and 2009.
- Socioeconomic status was determined by linking patients' postal codes to 2006 Canadian census income data, categorizing them into five quintiles.
- Observed patient distribution by SES was compared against an expected 20% distribution for each quintile.
Main Results:
- The study included 336 children diagnosed with amblyopia.
- Children from the highest income quintile were overrepresented (32.5%), while those from the three lowest quintiles were underrepresented (14.6%-15.5%).
- This disparity was statistically significant (p < 0.0001), with all amblyopia types under-represented in lower SES groups. Inequality persisted for non-metropolitan patients even after stratifying by travel distance.
Conclusions:
- Significant socioeconomic disparities exist in the utilization of pediatric amblyopia services in Canada.
- Children from lower socioeconomic neighborhoods, particularly those residing farther from the tertiary center, access amblyopia care less frequently.
- These findings highlight potential inequities in healthcare access within a publicly funded system that warrant further investigation and targeted interventions.
Objective:
To evaluate whether socioeconomic status is associated with equal utilization of amblyopia services at The Hospital for Sick Children (SickKids), a pediatric tertiary hospital in Canada.
Design:
This is a retrospective, cross-sectional study.
Participants:
The medical records of children aged under 7 years diagnosed with amblyopia at SickKids from 2007 to 2009 were reviewed.
Methods:
Socioeconomic status was derived from patients' residential postal codes through linking with income data in the 2006 Canadian census report. Patients were divided into 5 income quintiles to compare with amblyopia service utilization. The main outcome measure was the observed distribution of amblyopia patients by socioeconomic status versus the expected distribution of 20% for each quintile.
Results:
The analyses included 336 patients. Children with amblyopia at SickKids were more likely to come from the richest neighbourhood (32.5%), whereas children from each of the 3 lowest quintiles (14.6%-15.5%) were less likely to present at SickKids. These results differed significantly from the expected 20% for each quintile (p < 0.0001). All types of amblyopia were significantly under-represented for children from the lower socioeconomic groups. When analyses were stratified by travel distance to the hospital, a significant inequality between the lower and higher income quintiles remained for nonmetropolitan Toronto patients, but not for metropolitan Toronto patients.
Conclusion:
Despite a publicly funded health-care system in Canada, children from lower socioeconomic neighbourhoods in distant areas utilize the amblyopia services in a tertiary pediatric centre less often than those from higher socioeconomic status.
