Chantel Ramraj

Introduction The extant literature has examined social inequalities in high-risk categories of birth weight and gestational age (i.e., low birth weight and preterm birth) with little attention given to their distributional nature. As such, a scoping review was conducted to understand how researchers have conceptualized and analyzed socioeconomic inequalities in entire distributions of these birth outcomes. Methods Bibliographic databases were searched from their inception until August 2016 for articles from five similar, English-speaking, advanced capitalist democracies: Canada, United States, United Kingdom, Australia and New Zealand. Results Twenty-one studies were included in the review, all of which provided rationales for examining socioeconomic inequalities in the entire distribution of birth weight. Yet, only three studies examined non-uniform associations of socioeconomic factors across the distribution of birth weight using conditional quantile regression, while the majority focused on mean birth weight using descriptive analysis or linear regression to analyze inequalities. Nevertheless, study results indicated that socioeconomic inequalities exist throughout the distribution of birth weight, extending beyond the high-risk category of low birth weight. Discussion Although social inequalities in distributions of birth weight have been conceptualized, few studies have analytically engaged with this concept. As such, this review supports further investigation of distributional inequalities in birth outcomes using methodology which allows one to empirically quantify and explain differences in population risk distributions, rather than solely between infants born low birth weight or preterm birth, versus not.

Socioeconomic disadvantage is a fundamental cause of morbidity and mortality. One of the most important ways that governments buffer the adverse consequences of socioeconomic disadvantage is through the provision of social assistance. We conducted a systematic review of research examining the health impact of social assistance programs in high-income countries. We systematically searched Embase, Medline, ProQuest, Scopus, and Web of Science from inception to December 2017 for peer-reviewed studies published in English-language journals. We identified empirical patterns through a qualitative synthesis of the evidence. We also evaluated the empirical rigour of the selected literature. Seventeen studies met our inclusion criteria. Thirteen descriptive studies rated as weak (n = 7), moderate (n = 4), and strong (n = 2) found that social assistance is associated with adverse health outcomes and that social assistance recipients exhibit worse health outcomes relative to non-recipients. Four experimental and quasi-experimental studies, all rated as strong (n = 4), found that efforts to limit the receipt of social assistance or reduce its generosity (also known as welfare reform) were associated with adverse health trends. Evidence from the existing literature suggests that social assistance programs in high-income countries are failing to maintain the health of socioeconomically disadvantaged populations. These findings may in part reflect the influence of residual confounding due to unobserved characteristics that distinguish recipients from non-recipients. They may also indicate that the scope and generosity of existing programs are insufficient to offset the negative health consequences of severe socioeconomic disadvantage.

To explore the risk of visiting hospital emergency rooms (ERs) for dental problems not associated with trauma among a sample of working poor Canadians. Data stem from a telephone survey administered between March and August 2007 of working poor Canadians aged 18-64 years. Logistic regressions were employed to determine the predictors of reporting a visit to an ER for dental problems not associated with trauma. Approximately 6.1 percent of the sample reported visiting an ER in the past for a dental problem not associated with trauma. Those who were publicly insured, reported poor oral health, experienced a bed day due to dental pain, had dependent children, were lone parents, had competing needs, a history of receiving welfare, a history of an inability to afford dental care, and a perceived need for dental treatment were all more likely to have reported an ER visit. When adjusting for all variables, having experienced a bed day due to dental pain and a history of an inability to afford dental care were the dominant predictors of this outcome. A higher but not significantly different prevalence of ER visits for dental problems was found among the working poor sample when compared with the general Canadian population (6.1 percent versus 5.4 percent, P > 0.05). Further research is needed in order to provide insight into the reasons why the working poor population is seeking dental care in hospital settings.

To explore trends in access to dental care among middle-income Canadians. A secondary data analysis of six Canadian surveys that collected information on dental insurance coverage, cost-barriers to dental care, and out-of-pocket expenditures for dental care was conducted for select years from 1978 to 2009. Descriptive analyses were used to outline and compare trends among middle-income Canadians with other levels of income as well as national averages. By 2009, middle-income Canadians had the lowest levels of dental insurance coverage (48.7%) compared to all other income groups. They reported the greatest increase in cost-barriers to dental care, from 12.6% in 1996 to 34.1% by 2009. Middle-income Canadians had the largest rise in out-of-pocket expenditures for dental care since 1978. This study suggests that affordability issues in accessing dental care are no longer just a problem for the lowest income groups in Canada, but are now impacting middle-income earners as a consequence of their lack of, or decreased access to, comprehensive dental insurance.

Nationally representative clinical data on the oral health needs of Canadians has not been available since the 1970s. The purpose of this study was to determine the normative treatment needs of a nationally representative sample of Canadians and describe how these needs were distributed.

Abstract:  Objectives:  To explore self‐reported cost‐prohibitive dental treatment needs among Canadians.Methods:  Data were collected through a national telephone interview survey of 1006 randomly selected Canadian adults. Descriptive analyses based on socio‐demographic characteristics and dental‐related behaviours were undertaken. Logistic regression was used to determine the predictors of experiencing a cost‐prohibitive dental care need. Chi‐square tests were used to determine significant differences in the treatments reported as unaffordable by socio‐demographic characteristics and dental‐related behaviours.Results:  Those of low income, no insurance coverage and poor self‐rated oral health were more likely to report having a cost‐prohibitive dental care need. The top needs reported as unaffordable were fillings, cleanings and check‐ups. Comparatively, preventive services were selected as cost‐prohibitive more often by the insured, dentures by the oldest group and extractions by those with a high school education or less.Conclusions:  This study confirms that there are significant relationships between socio‐demographic factors, dental‐related behaviours and the types of dental services that are selected as unaffordable. Indirectly, this shows us how socio‐demographic factors may influence the types of dental services that are reported as ‘needed’ by certain groups. Difficulties in distinguishing between the services that are ‘needed’ from and those that are ‘wanted’ demonstrate some of the policy complexity associated with publicly financed dental care.