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Letters

Is it health care or is it health?

Peter Dodek, Keith Chan, Mathieu Simon and Robert Hogg
CMAJ April 03, 2001 164 (7) 968;
Peter Dodek
Centre for Health Evaluation and Outcome Sciences Program in Critical Care Medicine St. Paul's Hospital Vancouver, BC; Centre for Health Evaluation and Outcome Sciences St. Paul's Hospital Vancouver, BC; Program in Critical Care Medicine St. Paul's Hospital Vancouver, BC; Centre for Health Evaluation and Outcome Sciences St. Paul's Hospital Vancouver, BC
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Keith Chan
Centre for Health Evaluation and Outcome Sciences Program in Critical Care Medicine St. Paul's Hospital Vancouver, BC; Centre for Health Evaluation and Outcome Sciences St. Paul's Hospital Vancouver, BC; Program in Critical Care Medicine St. Paul's Hospital Vancouver, BC; Centre for Health Evaluation and Outcome Sciences St. Paul's Hospital Vancouver, BC
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Mathieu Simon
Centre for Health Evaluation and Outcome Sciences Program in Critical Care Medicine St. Paul's Hospital Vancouver, BC; Centre for Health Evaluation and Outcome Sciences St. Paul's Hospital Vancouver, BC; Program in Critical Care Medicine St. Paul's Hospital Vancouver, BC; Centre for Health Evaluation and Outcome Sciences St. Paul's Hospital Vancouver, BC
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Robert Hogg
Centre for Health Evaluation and Outcome Sciences Program in Critical Care Medicine St. Paul's Hospital Vancouver, BC; Centre for Health Evaluation and Outcome Sciences St. Paul's Hospital Vancouver, BC; Program in Critical Care Medicine St. Paul's Hospital Vancouver, BC; Centre for Health Evaluation and Outcome Sciences St. Paul's Hospital Vancouver, BC
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In the past 2 years, Maclean's has used a composite scoring system to rank health care services in Canada.1 However, the Maclean's scoring system includes components that are influenced by factors other than health care services. For example, life expectancy,2 low birth weight,3 and avoidable hospitalizations4 are all influenced strongly by socioeconomic factors such as income, employment and education.

We examined the relationship between each of average income, percent unemployment and the percentage of the population with a postsecondary education, and the Maclean's score for the same 50 health regions that the magazine studied. We obtained these socioeconomic data from Statistics Canada.5 For each relationship we calculated the Pearson correlation coefficient and associated p value. We found a significant linear relationship between each of the socioeconomic factors and the Maclean's score (r = 0.49 and p < 0.001 for average income, r = –0.70 and p < 0.001 for percent unemployment (Fig. 1), r = 0.52 and p < 0.001 for the percentage of the population with a postsecondary education).

Figure1
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Fig. 1: Correlation between percent unemployment and the Maclean's score for the 50 regions studied by the magazine.

Our findings highlight a need for caution when translating descriptions of health services into an overall assessment of health care. We recommend, along with others,6 that reports of clinical performance be adjusted for socioeconomic factors so that disparities in health care due to these factors can be emphasized and addressed.

References

  1. 1.↵
    Marshall R. The best health care. Maclean's 2000;113:18-21.
  2. 2.↵
    Lynch JW, Smith GD, Kaplan GA, House JS. Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. BMJ 2000; 320:1200-4.
    OpenUrlFREE Full Text
  3. 3.↵
    Rutter DR, Quine L. Inequality in pregnancy outcome: a review of psychosocial and behavioural mediators. Soc Sci Med 1990;30:553-68.
    OpenUrlCrossRefPubMed
  4. 4.↵
    Weissman JS, Gatsonis C, Epstein AM. Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. JAMA 1992;268: 2388-94.
    OpenUrlCrossRefPubMed
  5. 5.↵
    Statistics Canada. Statistical profile of Canadian communities. Ottawa: Statistics Canada; 1996. Available: ceps.statcan.ca/english/profil/PlaceSearchForm1.cfm (accessed 2001 Feb 28).
  6. 6.↵
    Fiscella K, Franks P, Gold MR, Clancy CM. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA 2000;283:2579-84.
    OpenUrlCrossRefPubMed
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CMAJ
Vol. 164, Issue 7
3 Apr 2001
  • Table of Contents
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  • Canadian Adverse Drug Reaction Newsletter (1038-1045)

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Is it health care or is it health?
Peter Dodek, Keith Chan, Mathieu Simon, Robert Hogg
CMAJ Apr 2001, 164 (7) 968;

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Peter Dodek, Keith Chan, Mathieu Simon, Robert Hogg
CMAJ Apr 2001, 164 (7) 968;
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