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Household income influences risk of death in infants with complex medical conditions


New research shows a strong correlation between family income and hospital admissions and deaths of infants born with a variety of complex chronic conditions, such as congenital malformations or other serious medical conditions of infancy. The study was conducted by researchers at the Institute for Clinical Evaluative Sciences (ICES), The Hospital for Sick Children (SickKids), and the University of Toronto.

“The link between the effects of low income and deaths, as well as hospital admissions is well documented. Access to care is one major factor that contributes to this. But few studies have examined the effect on medically fragile infants, who clearly have greater healthcare needs and a much higher risk of poor outcomes. We expected that with universal health insurance, infants with chronic complex conditions, identified at birth, would have equal access to medical care and discharge follow-up plans that should take account of social vulnerability. But sadly, what we discovered was the effects of low income on health outcomes is not minimized in this group of chronically ill infants,” says Dr. Chengning Wang, lead author on the study and a resident at SickKids.

The study used the hospital data for more than 500,000 infants born in Ontario hospitals to identify infants with complex chronic conditions, as well as deaths and hospital admissions. The neighbourhood average family income was determined for each infant by the neighbourhood they lived in at birth. The numbers of deaths and hospital admissions for those living in the lowest income neighbourhoods were compared to those living in the highest income neighbourhoods, taking into consideration other factors, such as having a low birth weight.

The study showed:

  • One in every 50 infants delivered in hospital in Ontario had at least one complex chronic condition, such as a major congenital malformation, organ disease, or metabolic disorder at the time of discharge after birth.
  • Infants with complex chronic conditions accounted for more than one-third of the deaths and one-tenth of hospital admissions for all infants during the first year of life.
  • The group of infants with chronic complex diseases living in neighbourhoods with low average family income had more deaths and admissions to hospital than infants with similar conditions from families in neighbourhoods with high average family income.
  • Infants with complex conditions living in the lowest income neighbourhoods at birth had a rate of death and hospital admission that was 25 per cent higher than those living in the highest income neighbourhoods.
  • Infants with chronic complex conditions already have a substantially higher overall risk of hospital admission and death compared to infants without these conditions. Therefore, the increased relative risk of hospitalization and death relating to low neighbourhood income is associated with significant numbers of deaths and admissions in this group of chronically ill infants.

“Under universal health insurance, infants with chronic complex conditions who are born to families from low neighbourhood income areas still appear to have poorer outcomes. Access to care, as well as other factors such as safety in homecare and environmental risks, could all have contributed this observed association,” says Wang.

Author affiliations: ICES (Guttmann, To, Dick); Child Health Evaluative Sciences, Research Institute (Wang, Guttmann, To, Dick); Division of Paediatric Medicine, The Hospital for Sick Children (Guttmann, To, Dick) Departments of Paediatrics and Health Policy, Management and Evaluation, U of T (Guttmann, To, Dick); Grey Bruce Health Services (Dick) Ontario, Canada.

The study “Neighbourhood income and health outcomes in infants: how do those with complex chronic conditions fare?” is in the July, 2009 issue of Archives of Pediatrics and Adolescent Medicine.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


Read the Journal Article