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Health screening in Ontario is lowest in low-income, high-immigration neighbourhoods, research shows

Sept. 30, 2013

A new study shows that people who live in disadvantaged neighbourhoods in Ontario are least likely to have screening tests for chronic conditions and cancer, even though these tests are covered by OHIP.

Researchers found gaps in screening for diabetes, high cholesterol, breast cancer, cervical cancer and colorectal cancer, with the lowest screening rates in neighbourhoods with low incomes and a high proportion of immigrants.

A health screening is a test that looks for signs of illness in healthy people with no symptoms. It helps catch diseases early, when they are most treatable, and is an important part of healthcare. The study notes that the following screening tests are recommended in Ontario:

  • diabetes testing every three years in all people over age 40
  • cholesterol testing every five years in all women over age 50 or who are menopausal, and all men over age 40
  • colon cancer screening in all people ages 50 to 74
  • breast cancer screening (mammography) every two to three years in women ages 50 to 74
  • cervical cancer screening (Pap test) every three years in women ages 21 to 69

Researchers from the Institute for Clinical Evaluative Sciences (ICES) in Toronto used Ontario health records and neighbourhood income data to look at screening rates in different groups of people. Using postal codes and information from the Canadian census, they sorted neighbourhoods into four categories, from least advantaged to most advantaged: 1) low income, high immigration, 2) low income, lower immigration, 3) higher income, high immigration and 4) higher income, lower immigration.

The study included records for 7,652,592 women and men. Screening rates were higher for women than men. Overall screening rates for the whole province included:

  • 72.9 per cent of women and 61.4 per cent of men were screened for diabetes
  • 82.4 per cent of women and 70.3 per cent of men were screened for high cholesterol
  • 61.6 per cent of women and 55.1 per cent of men were screened for colorectal cancer
  • 59.9 per cent of women were screened for breast cancer
  • 63.4 per cent of women were screened for cervical cancer

However, the lowest screening rates were found in the most disadvantaged areas:

  • 66 per cent of women and 52 per cent of men were screened for diabetes
  • 77 per cent of women and 61 per cent of men were screened for high cholesterol
  • 48.6 per cent of women and 40.6 per cent of men were screened for colorectal cancer
  • 45.7 per cent of women were screened for breast cancer
  • 52 per cent of women were screened for cervical cancer

The difference in screening rates between the least and most advantaged was smaller for diabetes and high cholesterol than for cancer. The study authors suggest this may be because those tests are simpler and less invasive (a blood test, compared to an X-ray or Pap test, for example), and the conditions are less alarming.

The researchers also suggest possible reasons why people in disadvantaged areas may be less likely to be screened. These include financial reasons, such as being unable to afford to miss work to go to the doctor, or being unable to pay for transportation costs. Disadvantaged people may also be less likely to have a primary care doctor, which means they are less likely to get a screening recommendation. For recent immigrants, issues such as cultural beliefs, language barriers and low health literacy may also be factors.

The study authors propose that a more streamlined screening program, and outreach that targets people in more vulnerable communities might help close the gap between the least advantaged and most advantaged Ontarians.

The study was published in the Canadian Journal of Public Health on Sept. 16, 2013.

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  • A publication of:
  • Women's College Hospital