title: Socioeconomic status influences care of patients with acne in Ontario, Canada.
abstract: BACKGROUND
  Canada's universal health care system is designed to ensure equitable access to medical care based on need rather than socioeconomic status, although a number of studies indicate a preferential access and greater use of specialist services for those patients in higher socioeconomic groups.
  
  
  OBJECTIVE
  The primary objective of this study was to determine whether socioeconomic status influences access to specialist care by a dermatologist for the management of acne in Ontario, Canada. A secondary objective was to determine whether the urban-rural dwelling status of patients affects access to specialty care.
  
  
  METHODS
  We conducted a population-based cohort study using administrative health care databases covering more than 12 million residents of Ontario. Individuals age 12 to 27 years with a new diagnosis of acne by a general practitioner were identified as belonging to 1 of 5 socioeconomic groups based on median annual neighborhood household income. Patients were then observed for 2 years after the index visit to identify visits to a dermatologist. The main outcome measure was visitation to a dermatologist within 2 years of an initial diagnosis of acne.
  
  
  RESULTS
  The study cohort consisted of 295,469 patients given a diagnosis of acne by their primary care physician of which 59,799 (20%) were subsequently referred to a dermatologist. Of those in the lowest income group of less than Can dollars 20,000, 17% were referred to a dermatologist, as compared with 24% in the highest income group of greater than Can dollars 80,000 (P value for trend < .001). Furthermore, patients living in an urban area had a 43% greater likelihood of being referred to a dermatologist (odds ratio 1.43, 95% confidence interval 1.39-1.48) as compared with patients in a rural location.
  
  
  CONCLUSIONS
  Limitations of our study include imputing socioeconomic status of patients on the basis of median income at the neighborhood level rather than on the basis of data on individual patients. Furthermore, our use of administrative databases did not allow us to characterize the severity of acne in our population cohort and whether that would affect referral patterns.
  
  
  CONCLUSIONS
  Within Canada's universal health care system, those likely to be in lower socioeconomic groups are significantly less likely to visit a dermatologist for specialist consultation.
authors.affiliation: Division of Dermatology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Aamir
authors.initials: A
authors.lastname: Haider
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mamdani
authors.forename: James C
authors.initials: JC
authors.lastname: Shaw
authors.forename: David A
authors.initials: DA
authors.lastname: Alter
authors.forename: Neil H
authors.initials: NH
authors.lastname: Shear
mesh_terms: D000152:Acne Vulgaris / Q000191:economics / Q000628:therapy*; D000293:Adolescent; D002648:Child; D003880:Dermatology / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007182:Income; D016014:Linear Models; D015999:Multivariate Analysis; D009864:Ontario; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012923:Social Class