Income inequality and health in Ontario: a multilevel analysis.

OBJECTIVE: To examine the association of income inequality at the public health unit level with individual health status in Ontario. METHODS: Cross-sectional multilevel study carried out among subjects aged 25 years or older residing in 42 public health units in Ontario. Individual-level data drawn from 30,939 respondents in 1996-97 Ontario Health Survey. Median area income and income inequality (Gini coefficient) calculated from 1996 census. Self-rated health status (SRH) and Health Utilities Index (HUI-3) scores were used as main outcomes. RESULTS: Controlling for individual-level factors including income, respondents living in public health units in the highest tercile of income inequality had odds ratios of 1.20 (95% CI 1.04 - 1.38) for fair/poor self-rated health, and 1.11 (95% CI 1.01 - 1.22) for HUI score below the median, compared with people living in public health units in the lowest tercile. Controlling further for median area income had little effect on the association. CONCLUSION: Income inequality was significantly associated with individual self-reported health status at public health unit level in Ontario, independent of individual income.

On the classification of population health measurements.

Summary measures of population health, such as health-adjusted life expectancy, are increasingly being used to monitor the health status of regions and to evaluate public health interventions. Such measures are based on aggregated indicators of individual health and summarize health in a population. They describe population health status but have limitations in analytic studies of population health. We propose a broader framework for population health measurement. This classifies indicators according to their application (descriptive, prognostic, or explanatory), according to the conception of population (as an aggregate or a dynamic entity), and according to the underlying model of health. This approach extends the measurement repertoire to include indicators of the health of a population.

An epidemiologically-based needs assessment for stroke services.

Stroke is amenable to the entire spectrum of health services, ranging from prevention of its risk factors, to the treatment of acute stroke and rehabilitation and palliation of stroke. The aim of this study was to determine the number of persons with the capacity to benefit from evidence-based effective stroke services. Population-based survey and registry data along with published, evidence-based recommendations for services were used to determine the number of persons in Eastern Ontario with stroke (including risk factors, acute stroke and chronic stroke) and their related need for services (including prevention programs, diagnostic services, treatment of acute stroke and rehabilitation). These estimates were then compared to the actual provision of these services. Estimates of the need for effective services exceeded the provision of all services with the exception of pharmacologic treatment for diabetes mellitus and carotid endarterectomy for acute stroke. The approach was able to identify both the under-provision and over-provision of evidence-based effective services for stroke. This study has shown that an epidemiologically-based needs assessment could be a useful basis for the planning of health services.

Restricted driver licensing for medical impairments: does it work?

BACKGROUND: Medical conditions may adversely affect driving ability. Many North American jurisdictions provide restricted driving licences that permit people with certain medical conditions to drive under limited conditions, but the effectiveness of such programs has not yet been determined. The objectives of this study were to evaluate the rates of crashes and traffic violations among drivers with a restricted licence, compared with the rates in the general driving population, and to compare the crash and traffic violation rates before and after driving restrictions were imposed. METHODS: We retrospectively analyzed a cohort of all licensed Saskatchewan drivers registered from Jan. 1, 1992, to Apr. 19, 1999. The cohort was divided into those with a restricted licence and those with an unrestricted general licence. We used multivariate Poisson regression to calculate incidence rate ratios (IRRs) for at-fault crashes and traffic violations, adjusting for age, sex and residence (urban v. rural). We used interventional time series analysis to compare rates of crashes and traffic violations before and after the imposition of driving restrictions. RESULTS: Of the 703,758 drivers in the study, 23,185 (3.3%) had a restricted licence. Restricted licence holders had a higher crash rate than drivers without restrictions (adjusted IRR 1.13, 95% confidence interval [CI] 1.11-1.17). However, this rate was lower than that among male drivers (adjusted IRR 2.01, 95% CI 1.99-2.02) and urban drivers (adjusted IRR 1.38, 95% CI 1.37-1.39). Drivers with restricted licences had a lower traffic violation rate than those without restrictions (adjusted IRR 0.93, 95% CI 0.91-0.95). At-fault crash rates decreased by 12.8% (95% CI 2.4%-23.2%) and adjusted traffic violation rates decreased by 10.0% (95% CI 4.4%-15.7%) after restrictions were imposed. During the study period, licence restrictions likely averted up to 816 crashes and 751 traffic violations. INTERPRETATION: Province-wide population data suggest that a restricted licensing program appears to provide a significant decrease in the rates of crashes and traffic violations.