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Withdrawn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

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