Poorer Canadians are more likely to enter hospital for health problems such as child asthma, mental illness and diabetes, including potentially preventable conditions, according to a report released Monday.

The study by the Canadian Institute for Health Information, called Reducing Gaps in Health: A Focus on Socio-Economic Status in Urban Canada, compared hospitalization rates for various illnesses in the country's 15 largest urban areas, representing two-thirds of the urban population.

Urban Canadians in the lowest socio-economic groups, based on income, education and employment, were more likely to be hospitalized for chronic conditions that could be treated in the community, the study's authors found for the three-year period between 2003 and 2006.

The gaps are important partly because it is often costlier to the public-health system to treat people in hospital than in the community.

"I think it's important for Canadians to see that this is in fact a problem here as well, it's not just a problem of developing countries," said Dr. Cordell Neudorf, chair of the Canadian Population Health Initiative Council and chief medical officer of health for the Saskatoon Health Region.

"We have pockets of deprivation and it's having serious health outcomes."

For example, after factoring out age in all cases:

• Children from low socio-economic groups had 56 per cent higher hospitalization rates for asthma than children from high socio-economic groups (233 per 100,000 people in the low group compared with 149 per 100,000 in the high group).
• People from lower-income groups were 2.4 times more likely to be hospitalized for diabetes than those in wealthiest group (102 per 100,000 in the low socio-economic group compared with 43 per 100,000 in the high socio-economic group).
• Among people with mental illness, hospitalization rates were 2.3 times higher for those in the low-socioeconomic group compared with the high group (596 per 100,000 people compared with 256 per 100,000).

By knowing where the health gaps are the widest, policy makers could target programs to gain the biggest bang for the buck, Neudorf said.

Smoking, obesity need different approaches

In terms of self-reported health, for example, 30 per cent of poorer Canadians said they smoked compared with 17 per cent in the high socio-economic group.

Public campaigns such as bans on smoking in public places and tax changes seem to have paid off in reduced smoking rates among higher and middle income Canadians, so smoking cessation programs could now focus on helping those with the lowest incomes or greatest deprivation, Neudorf said.

On the other hand, there were virtually no gaps between the income groups for rates of influenza immunization among seniors (63 per cent in the low group compared with 68 per cent in the high group), and being overweight or obese (48 per cent versus 44 per cent).

Where the gap is small, such as self-reported obesity rates, a general approach that encourages physical activity for all Canadians could help, Neudorf said.

Of the 15 urban areas examined in the study, Regina and Winnipeg had the most profound differences in hospitalization rates of people in different socio-economic groups, while Ottawa-Gatineau and Toronto showed more consistent rates across the three income groups, the report's authors said.

Hospitalization rates for mental illness among the poorest people living in Regina, for example, were about 4.5 times that of the wealthiest group, while the rate difference was two times between the same income groups in Ottawa-Gatineau.

Neudorf was joined by colleagues from other Canadian cities on Monday at the Chronic Disease Prevention Alliance of Canada's national conference in Ottawa. The alliance's members called on governments to recognize the problems and search for solutions that not only improve medical care but also combat poverty and reduce social and economic inequality.

Programs such as low-cost daycare and subsidized social housing help lift people into the labour force and out of poverty, with a ripple effect of improving health, said Dr. Richard Lessard, director of public health for the city of Montreal.

The report's authors also found income gaps were smaller for low-birth-weight babies (6.9 per 100 live births in the low socioeconomic group versus 5.6 per 100 live births in the high socio-economic group) and hospitalization for injuries in children (330 per 100,000 versus 274 per 100,000).

The report included interactive Google Earth maps to visualize how the study divided socioeconomic groups within urban areas.

With files from Canadian Press