Measuring Trends in Health Inequalities across Urban Cities in Canada: A Focus on Health System Outcomes
Bibliographic record
Abstract
IntroductionThe majority of Canadians live in cities, which have experienced rising income inequality. This study examines how socio-economic inequalities in health system outcomes vary across and within Canada’s major cities over time to better understand these differences and to support informed decision-making and public policy planning to reduce inequalities. Objectives and ApproachThis study links a range of hospitalization indicators with neighbourhood income quintile and city geography data using patient postal codes and Statistics Canada’s Postal Code Conversion File Plus (PCCF+). Age-standardized indicator rates were calculated and income-related health inequalities were summarized using disparity rate ratio (DRR), disparity rate difference (DRD) and relative concentration index (RCI). Data were pooled across five-year intervals and linked to Census data years (2006, 2011, and 2016). City (Census Metropolitan Areas (CMAs)) and sub-city (Census Subdivisions (CSDs)) results enabled comparisons within and across cities and provided local level information to strengthen measuring and monitoring of health inequalities. ResultsAnalysis of the age-standardized rates for the hospitalization indicators (Hospitalizations for COPD (less than 75 years), Heart Attacks, Injury, Stroke, Self-Injury, Opioid Poisoning, Ambulatory Care Sensitive Conditions, and Hospitalizations Entirely Caused by Alcohol), overall and by neighborhood income quintile revealed an income gradient and significant variations within and across the CMAs and over time. Variations in DRR, DRD and RCI results were also observed across the CMAs over time, and between the CSDs within a CMA. Income-related inequalities in some hospitalization indicators persisted in Canada’s major cities with trends showing that people from lower income neighbourhoods experienced increased rates of hospitalization compared to people from higher income neighbourhoods. Conclusion/ImplicationsThis is the first study examining socio-economic health inequalities at city and sub-city levels across Canada. The methods used are relevant to others interested in local health inequality measurement. Our analysis provides evidence for developing and targeting public policy and health interventions to improve outcomes for vulnerable populations within cities.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".