World Health & Population

World Health & Population 15(2) March 2014 : 32-42.doi:10.12927/whp.2014.23859
Neighbourhood Variation and Inequity of Primary Health Service Use by Mothers

Neighbourhood Variation and Inequity of Primary Health Service Use by Mothers from London–Middlesex, Ontario

Catherine Holtz, Jason Gilliland, Amardeep Thind, Piotr Wilk and M. Karen Campbell


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.



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