Equity Concerns in Canadian Rural Health Care - Research Paper Example

?Annotated Bibliography: Equity concerns in Canadian rural health care This annotated bibliography consist of the best journal articles that reflected “Canada” in the title line and the word “rural” among the journal articles in jstor.org during 2002-12. Borugian, M., Spinelli, J., Mezei, G., Wilkins, R., Abanto, Z., and McBride, M. (2005). Childhood leukemia and socioeconomic status in Canada. Epidemiology, 16 (4), 526-531. Employing quantitative techniques, Borugian et al. (2005) provided evidence of an association between socioeconomic status and childhood asthma. Borugian et al. (2005) did not directly really address equity issues in Canada’s rural health care. However, one way of interpreting the Borugian et al. (2005) article is that when we are able to correlate select socioeconomic variables with the rural sector of Canada, cases of childhood leukemia may negatively correlate with Canada’s rural socioeconomic characteristics. One key result that Borugian et al. (2005) supposedly found is that a slightly lower relative risk of childhood leukemia was observed in the poorest quintile compared with the richest quintile. Thus, when we succeed in showing that Canada’s rural population is associated with the poorest quintile, it may be possible to show that Canada’s rural population is also associated with lower childhood leukemia. Borugian et al. (2005) recognize that other studies have results that are inconsistent with their own findings but Borugian et al. (2005) interpreted the inconsistent findings to be due to case ascertainment or study participation. It is worth noting that Borugian et al. (2005) also revealed that the provincial registries cover at least 95% of all Canadian cancer cases. Thus, the Borugian et al. (2005) finding appears inconsistent with the data on cancer prevalence. Nevertheless, following the Borugian et al. (2005) key finding on the presumed slightly negative association between the poorest quintile and childhood leukemia in Canada, it should follow that there is a lower prevalence of childhood asthma in Canada’s rural population. A possible interpretation that can be advanced is that income inequity in Canada favours the rural health and the lower income that may be associated with Canada’s rural population need not be associated with inferior health well-being. James, P., Wilkins, R., Detsky, A., Tugwell, P., and Manuel, D. (2007). Avoidable mortality by neighbourhood income in Canada: 25 years after the establishment of universal health insurance. Journal of Epidemiology and Community Health, 61, 287-296. Employing quantitative techniques, the James et al. (2007) study highlights the role of universal insurance for doctors and hospital services in Canada. According to James et al. (2007), the results after 25 years of universal health insurance indicate that health differences between the riches and poorest quintiles based on age-standardized expected years of life lost decreased by 60% in men and by 78% in women. The James et al. (2007) study has a list of illnesses or conditions in which deaths may be avoidable. One set of illnesses or conditions are those in which deaths can be avoided through medical care and another set consist of illnesses and conditions in which deaths can be avoided through public health programs. It follows from the James et al. (2007) that mortality from illnesses and conditions are functions of public policy. Public policy can institute reforms in health insurance access and in improving medical care and public health. Thus, one extension of the study results of James et al. (2007) is that health inequities produced by the urban-rural divide can also be moderated by public policy. Meanwhile, among the illnesses or conditions in which there has been only marginal decreases in mortality disparities across incomes include lung cancer, HIV, and cerebro-vascular diseases. James et al. (2007) noted that another important contributory factor to the reduction of health disparities is the increase in government funding for public health that was only 4.4% in 1975 but has increased to 6.5% in 1996. Jerret, M., Eyles, J., Dufurnaud, E., and Birch, S. (2003). Environmental influences on healthcare expenditures: An exploratory analysis from Ontario, Canada. Journal of Epidemiology and Community Health, 57(5), 334-338. The study of Jerret et al. (2003) is another study that can be interpreted or argued to mean that rural health is superior to urban health and, thus, rural health inequity is a false issue or a concern that does not have to be addressed. The central result of the Jerret et al. (2003) study is that toxic pollution positively and significantly correlates with per capita healthcare expenditures (HCE) while municipal expenditures to defend environmental quality negatively correlates with HCE. Thus, this implies that the extent that environmental quality is protected in the rural areas, rural health need not be associated with inferior health. However, the Jerret et al. (2003) interpretation of their research involves two main points: first, sound investments in public health and environmental enhancement result to lower HCEs and, second, a health policy that do not consider environmental quality results to higher HCEs. The Jerret et al. (2003) study used regression analysis and reported statistically significant regression coefficients involving small p-values of the coefficient. However, the adjusted r-squared of the Jerret et al. (2003) regression is from 63-67% which may not indicate very convincing results. There are also regression values that suggest suspicious regressions or spurious regressions. For instance, education and manufacturing are supposedly negatively associated with mortality but the latter is supposedly positively associated with health expenditure and primary industry. In short, the regressions used by the Jerret et al. (2003) study do not produce a pro-intuitive interpretation. Jin, T., Marrie, J. Carrier, K., Predy, G., Houston, C., Ness, K., and Johnson, D. (2003). Variation in management of community-acquired pneumonia requiring admission to Alberta, Canada Hospitals. Epidemiology and Infection, 130 (1), 41-51. Jin et al. (2003) investigated the variations in management of community-acquired pneumonia that required admission to Alberta, Canada hospitals and found hospital discharge rates in rural regions are significantly higher than those in the non-rural regions. In contrast, Jin et al. (2003) noted that the length of stay was 22% higher in regional hospitals and 30% higher in urban hospitals. The Jin et al. (2003) study controlled for variables like severity of illness, age, gender, co-morbidity and other variables. Jin et al. (2003) computed for the statistical significance of the rates differences using T-statistics and found that the rates differences were statistically significant. The Jin et al. (2003) study covered 43,642 acute patients and 36,516 unique patients over a study of five years and, thus, can be considered highly reliable in view of its large sample and long period involved in the study. Various statistical tools were used for the study like multiple logistic regressions, ANOVA, and the similar tools in regression analysis. Nevertheless, Jin et al. (2003) noted that among the limitations of their study were that hospital discharges has been generally higher in regional and rural hospitals and fewer in urban hospitals. Further, Jin et al. (2003) also noted that co-morbidity increases from rural to urban hospitals. In other words, it may not be really clear whether the co-morbidity was really adequately controlled in the Jin et al. (2003) study. In sum, while Jin et al. (2003) attempted to put statistical controls on the variables that may distort the findings of their study, we may not be assured whether the results of the Jin et al. (2003) study have really adequately controlled variables that can lead to spurious results. Thus, we are unable to interpret whether the Jin et al. (2003) study can be interpreted as indicative of lopsided care in favour of urban areas or whether the longer stay of patients in urban areas is simply reflecting the more serious pneumonia cases in the urban areas. In any case, the overall insight of the Jin et al. (2003) study is that rural hospitals are likely to benefit from improvements in the protocol on admissions. Odoi, A., Martin, S., Michel, P., Holt, J., Middleton, D., and Wilson, J. (2004). Epidemiology and Infection, 132 (5), 967-976. Odio et al. (2004) investigated the determinants of the geographic distribution of endemic giardiasis in sourthern Ontario, Canada, and found higher rates of giardiasis were observed in rural areas compared to non-rural areas. However, they also found that lower rates are observed in using filtered water and those with higher income. Odio et al. (2004) also found that higher rates are found in communities using surface water than ground water. According to Odio et al. (2004), giardiasis is associated with giardia lamblia, a most frequently identified intestinal parasite in North America. Odio et al.’s (2004) study covered 93% of Ontario’s total population. Based on Table 4 of the Odio et al. (2004) study, being a rural area is the most significant determinant of giardiasis rates based on the coefficient-to-standard error compared to other variables like surface water, water filtration, and median income. In Odio et al.’s (2004) discussion of their research results, it was suggested that animals or animal manure may be contributing to the role of geographical location and giardiasis but nowhere is the assertion supported by the Odio et al. (2004) statistical results. The Odio et al. (2004) study used regression statistics and employed ordinary least square, Jackknife, spatial error, and spatial moving average modeling. In all of the four models, the consistent role of rural location has been a significant determinant of giardiasis. Nevertheless, the Odin et al. (2004) regression figures do not appear to support a claim that health equity issues or concerns play a role on the higher rates of giardiasis in rural areas. It appears that the higher giardiasis rates in rural areas are a function of having animals and animal manure in the rural areas that are contaminating the sources of water. Serra-Majem, L, MacLean, D., Ribas, L., Brule, D., Sekula, W., Prattala, R., Garcia-Closas, R., Yngve, A., Lalone, M., and Petrasovits, A. (2003). Comparative analysis of nutrition data from national, household, and individual levels: Results from a WHO-CINDI collaborative project in Canada, Finland, Poland, and Spain. Journal of Epidemiology and Community Health, 57 (1), 74-80. Serra-Majem et al. (2003) compared the components of Canadian diet in comparison with Finland, Poland, and Spain. The dietary data for Canada included a rural and urban component. However, Serra-Majem did not disaggregated the Canadian data between rural and urban diets and instead standardize urban and rural data into a national Canadian diet. According to Serra-Majem et al. (2003), Canadian food intake are much higher relative to the mean of the four countries in meat, nuts and oils, and sugar and honey. In contrast, Canadian food intake is lower relative to the mean of four countries in dairy products, fish, eggs, roots and tubers, and cereals. Unfortunately, the Serra-Majem study failed to make a sensible conclusion beyond saying that their results suggest that it is difficult to compare the variations in food intake across countries. Further, the Canadian food intake data covering rural and urban data were consolidated such that the Serra-Majem (2003) study failed to maximize the utility of their data. A better study of the Serra-Majem study could have correlated the food intake variations across countries and between urban and rural geographies with morbidity and mortality figures. Annex: Copies of the abstract/summary of the Journals discussed Read More