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Neighbourhood variation and inequity of primary health service use by mothers from London-Middlesex, Ontario
World Health & Population
  • Catherine Holtz, Western University
  • Jason A. Gilliland, Western University
  • Amardeep Thind, Western University
  • Piotr Wilk, Western University
  • M. karen Campbell, Western University
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Objective: Primary health service use (P-HSU) may be influenced by contextual characteristics and is equitable when driven by need. Contextual effects and inequity of maternal P-HSU were determined.

Methods: Participant data from a London-Middlesex, Ontario, prenatal cohort were linked by residential address to contextual characteristics. Multilevel logistic regression estimated contextual effects and tested for effect measure modification of need factors.

Results: Maternal P-HSU varied between neighbourhoods. The effect of obesity was different for rural mothers living in low- (OR = 0.26) and middle-income households (OR = 0.15) and for urban mothers living in high-income households (OR = 2.82). The effect of having a health condition was greatest in mothers with three or more children (OR = 2.41).

Discussion: Differences in maternal P-HSU exist between neighbourhoods, and enabling factors modified need factors' effects, identifying subgroups of mothers with inequitable P-HSU. RESULTS have the potential to inform Canadian health policy with regard to contextual effects and inequity of P-HSU.

Citation Information
Catherine Holtz, Jason A. Gilliland, Amardeep Thind, Piotr Wilk, et al.. "Neighbourhood variation and inequity of primary health service use by mothers from London-Middlesex, Ontario" World Health & Population Vol. 15 Iss. 2 (2014) p. 32 - 42
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