Article Text

  1. M M Agha1,2,3,8,
  2. R Glazier1,2,3,5,7,
  3. G Astrid2,4,6,7,
  4. R Moeineddin1,2,3,5
  1. 1Centre for Research on Inner City Health, St Michael’s Hospital, Toronto, Ontario, Canada
  2. 2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  3. 3Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
  4. 4Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
  5. 5Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  6. 6Department of Pediatrics and University of Toronto, Toronto, Ontario, Canada
  7. 7Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  8. 8Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada


By improving survival among children diagnosed with major diseases, evaluating the impact of these conditions on children, their healthcare utilisation and the healthcare system is becoming more and more important. These children live with disabling consequences of their diseases, treatment for their conditions, or disabilities, which put them in a specific position with respect to their healthcare needs. Children from poor families represent a greater share of ill health. Improving and providing greater equity in health coverage could greatly reduce health disparities.

Our main objectives are to evaluate the socioeconomic determinants and pattern of health services utilisation; specifically, where they receive their access to specialists, specialised referral centres and continuity of care among children diagnosed with major chronic conditions (MCC).

Among all children born in Ontario during 1993–2004, children diagnosed with MCC and with major birth defects (MBD) were identified. Healthy children and those born with very low birth weight (LBW) were used as controls. They were followed till the end of 2007 and data on hospitalisation, physician visits and emergency room visits were collected.

Among 1 604 000 children born in Ontario, 7200 diagnosed with MCC, 112 000 with MBD, 8400 with LBW and 1 409 000 healthy children were identified. The incidence rate of MCC among children from low income areas was 15% higher than the rate in wealthy areas (4.7/1000 vs 4.1/1000). Similar results were found for MBD (relative risk (RR) 1.21) and LBW (RR 1.32). The early results of this ongoing cohort study, including trend over time for hospitalisations, physicians and emergency room visits, will be presented.

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