Socioeconomic status and health-care utilisation in Canadians with asthma

Abstract

Asthma emergency department (ED) visits and hospitalization represent a great burden on the Canadian population in terms of morbidity and health expenditures. This thesis aims to understand the influence of socioeconomic status (SES) on these outcomes. This cross-sectional analysis of the NPHS 1996 Asthma Supplement was based on data from 1814 respondents with asthma. After controlling for various individual-level factors, measures of low SES (low education, low income and high unemployment) at the community level were strong predictors of increased risks of having at least one ED visit or having at least one hospitalization. At the household level, middle-income was associated with greater likelihood of hospitalization but not ED visits, whereas low education and unemployment were related to greater likelihood of ED visits. The relationship between ED visits or hospitalization and SES was not explained by more contacts with key primary health services. The greater use of ED visits among those with low household income was stronger in respondents reporting rare or no asthma symptoms as opposed to those with frequent or continuous symptoms. They may have altered symptom perception. The independent association of area-level SES with hospital use among individuals with asthma needs further research to identify the specific factors that could be the basis of community-based interventions to improve asthma control.