Epidemiol Health.  2018;40:e2018010. 10.4178/epih.e2018010.

Socioeconomic disparities and difficulties to access to healthcare services among Canadian children with neurodevelopmental disorders and disabilities

• Raouafi S
• Achiche S
• Raison M

• KMID: 2438465
• DOI: http://doi.org/10.4178/epih.e2018010

Abstract

OBJECTIVES
The aims of this study were to identify the associations of levels of severity of neurodevelopmental disorders and disabilities (NDD/D) in children with their household socioeconomic status (SES) and their frequency of visits to a healthcare provider, and to examine how the severity of disability varied with these determinants among NDD/D subgroups, in order to inform possible social policy changes and to improve access to the healthcare system.
METHODS
Data from the 2006 Participation and Activity Limitation Survey on children aged 5-14 years, collected by Statistics Canada, were analyzed (n=7,072 and weighted n=340,340). Children with NDD/D constituted those with impairments in motor, speech, neurosensory, and psychological functioning, as well as those who had issues with learning/cognition and social interactions. The weighted sample size for this group was n=111,630 (total sample size for children with limitations: n=174,810). We used logistic regression to assess the associations of household SES and frequency of visits to a healthcare provider with disability level. We included NDD/D subgroups as interaction terms in the model. Multiple correspondence analysis (MCA) was conducted to develop a profile of disability level.
RESULTS
After-tax low income, family assistance, out-of-pocket expenses, needing but not receiving health services from a social worker, condition of the dwelling, and residential location were associated with the severity of NDD/D. Using MCA, 2 disability profiles could be identified based on access to healthcare, household income status, and condition of the dwelling.
CONCLUSIONS
More social interventions are needed to reduce difficulties in accessing healthcare and to diminish the socially determined health inequalities faced by children with NDD/D.

Keyword

Neurodevelopmental disorders; Children with disabilities; Socioeconomic status; Inequalities

MeSH Terms

Canada
Child*
Delivery of Health Care*
Disabled Children
Family Characteristics
Health Expenditures
Health Personnel
Health Services
Humans
Interpersonal Relations
Logistic Models
Neurodevelopmental Disorders*
Public Policy
Sample Size
Social Class
Social Work
Social Workers
Socioeconomic Factors