title: Socioeconomic status and wait times for pediatric surgery in Canada.
abstract: OBJECTIVE
  Even in a publicly funded health care system, access to care may be related to socioeconomic status (SES). For children, delays in surgical procedures can have profound functional, social, and psychological effects with lifelong impact. The purpose of this study was to determine whether SES was related to meeting surgical wait time access targets for children. We also assessed the effects of gender, age, and distance to hospital on meeting access targets.
  
  
  METHODS
  Patient addresses, referral wait times, and surgical wait times were obtained for 39,287 surgical procedures between 2005 and 2011 at the Hospital for Sick Children. Using census data, we derived household income quintile, distance to hospital, and indices of social and material deprivation. These indices were correlated with the percentage of children meeting clinic referral wait time targets and receiving surgery within the Pediatric Canadian Access Targets for Surgery.
  
  
  RESULTS
  Across all SES quintiles, 33% of children exceeded their referral wait time targets, and 28% of children exceeded their surgical wait time targets. Indices of material or social deprivation and age did not correlate with the time from referral to clinic consultation (P = .54, .40, and .58, respectively). Gender was statistically significant (P < .001), but the difference was small (odds ratio = 0.87 for girls). Distance was also statistically significant (P = .005), and these differences translate into clinically meaningful differences in meeting wait time targets. Regarding completion of surgical procedures, material deprivation, distance, and gender did not correlate with longer wait times for surgery (P = .44, .09, .59, respectively). Social deprivation was statistically significant (P = .02) but not clinically significant. Increasing patient age was significantly associated with increased proportion of out-of-window wait times (P < .001). SES did not affect the timeliness of completion of surgery even when the urgency of the surgery (priority level based on diagnosis) was considered.
  
  
  CONCLUSIONS
  SES does not predict the timeliness of delivery for pediatric surgical services.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, and.
authors.forename: Mark
authors.initials: M
authors.lastname: Szynkaruk
authors.affiliation: Department of Biostatistics, and.
authors.forename: Derek
authors.initials: D
authors.lastname: Stephens
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, andInstitute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada; andProgram in Neuroscience, and gregory.borschel@sickkids.ca.
authors.forename: Gregory H
authors.initials: GH
authors.lastname: Borschel
authors.affiliation: Program in Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, CanadaDivision of Orthopaedic Surgery, The Hospital for Sick Children and University of Toronto, Toronto, Canada;
authors.forename: James G
authors.initials: JG
authors.lastname: Wright
mesh_terms: D002170:Canada; D006297:Health Services Accessibility; D006776:Hospitals, Pediatric; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D012923:Social Class; D013222:State Medicine; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014850:Waiting Lists
keywords: access targets; equal access health care; health care delivery; pediatric surgery; publicly funded health care; socioeconomic status; wait times