PATHS Equity for Children: a program of research aimed at monitoring equity in children’s outcomes
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Transcript of PATHS Equity for Children: a program of research aimed at monitoring equity in children’s outcomes
PATHS Equity for Children: a program of research aimed at monitoring equity in children’s
outcomes
Marni D. Brownell, PhDCPHA Annual ConferenceToronto, ON: May 27, 2014
Manitoba Centre for Health Policy (MCHP)• University of Manitoba, Faculty of Health Sciences,
College of Medicine, Department of Community Health Sciences
• Use a Repository of datasets to study health services, population and public health
• support the development of evidence-informed policy, programs and services that maintain and improve the health and well-being of Manitobans.
Using data in MCHP Repository to study child health and development
At birth:Birth weightGestational ageApgar scoresBreastfeeding ComplicationsFF screen
Preschool:Child care
School Entry:EDISchool enrolmentSpecial needs
(age 8)Grade 3 assessmentSchool enrolmentGrade retentionSpecial needs
(ages 11-13)Grade 7/8 assessmentsSchool enrolmentGrade retentionSpecial needs
(ages 14-19)Grade 12 assessmentsHigh school marksSpecial needsHigh school completion
Prenatal:FF screenPrenatal careMaternal serum screen
At all stages: health status (hospitalizations, doctor visits, medications prescribed), immunization, residence (area-level measures; region, number of moves), family composition (marital status, number of siblings), family or youth receipt of income assistance, involvement with child welfare, clinical datasets (e.g., FASD)
Birth/Health/Education Linkages
Grade 12 Performance by Socioeconomic Status (SES) Language Arts Standards Test
IA Low Lo-Mid Middle High0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
75%
88% 88% 91%95%
SES
Pass/Fail rates of test writers 17/18 year olds who should have written
IA Low Lo-Mid Middle High0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
16%
52%
64%71%
80%
Withdrawn
In Grade 11 or lower
In Grade 12 but not LA test mark
Drop Course, Absent, Exempt, Incomplete
Fail
Pass
SES
Brownell, Roos, Fransoo, et al., 2006
PATHS Equity: PAthways To Health and Social Equity
• Multi-disciplinary, cross-sector collaboration• Integrated KT• Use Repository to evaluate programs in childhood
– Did the program work?– Did the program reduce inequities?
• 14 separate sub-projects; integrative projectsThis Programmatic Grant to Reduce Health Inequity was supported by the Canadian Institutes of Health Research (www.cihr-irsc.gc.ca) and the Heart & Stroke Foundation of Canada
PATHS Projects
Project Year 1 Year 2 Year 3 Year 4 Year 5
Baby Friendly Hospital Initiative
Physician Integrated Network
Early Intervention for ADHD
Early Psychosis Prevention & Intervention
In-School Teen Clinics
Healthy Baby Program
Families First Home Visiting
Social Housing
CSI Summer Learning Enrichment
Healthy Buddies
Roots of Empathy
Full-Day Kindergarten
Qualitative Analysis: Understanding the Mechanisms of Inequity
Public Health Sensitive Conditions
Integrative Analysis
Manitoba Healthy Baby Program:• Compared low income women
receiving benefit to those not receiving
• Propensity Scoring used to ensure comparability of groups
Is receipt of the HB prenatal benefit associated with better outcomes?Has there been a change in equity?
Receipt of Healthy Baby Benefit
RR (95 % CI)
Breastfeeding Initiation 1.06 (1.03 - 1.09)*
Low 5-minutes Apgar Score 0.93 (0.79 - 1.09)
Low Birth Weight (< 2,500 g) 0.71 (0.63 - 0.81)*
Pre-term Birth (GA < 37 weeks) 0.76 (0.69 - 0.84)*
Small for Gestational Age 0.90 (0.81 - 1.00)*
Large for Gestational Age 1.13 (1.05 - 1.23)*
Complete Immunization (one year old) 1.13 (1.10 - 1.16)*
Complete Immunization (two year old) 1.20 (1.15 - 1.25)*
Hospital Readmission (within 28 days of birth) 1.02 (0.84 - 1.25)
Hospital Readmission (within 2 years of birth) 1.01 (0.94 - 1.09)
0.6 0.7 0.8 0.9 1.0 1.1 1.2 1.3 1.4
Relative Risk (95% CI)
Decrease Increase
Framework for Equities
• From our data we can form three groups:– Group 1: ELIGIBLE to receive Healthy Baby Benefit (Q1 to Q3)
and RECEIVED Benefit
– Group 2: ELIGIBLE to receive Healthy Baby Benefit (Q1 to Q3) and
DID NOT RECEIVE Benefit– Group 3: NOT ELIGIBLE to receive Healthy Baby Benefit (Q4
to Q5) DID NOT RECEIVE Benefit
Framework for EquitiesComparison A
(With Healthy Baby)Comparison B
(Without Healthy Baby)
LBWGROUP1 / LBWGROUP3 LBWGROUP2 / LBWGROUP3
LBW GROUP 1 - LBW GROUP 3 LBW GROUP 2 - LBW GROUP 3
• Test whether inequality in A is different from B
Health Baby Impact on Health Equality
Risk Difference
-1.2% -0.8% -0.4% 0.0% 0.4% 0.8% 1.2%
With Healthy Baby Benefit
LBW, High Income – LBW, Low Income
Without Healthy Baby Benefit
LBW, High Income – LBW, Low Income
Higher RiskLow Income vs.
High Income
Lower RiskLow Income vs.
High Income
Thank You / Questions• umanitoba.ca/centres/mchp • facebook.com/mchp.umanitoba• twitter.com/mchp_umanitoba (@mchp_umanitoba)