title: Socioeconomic status and utilization of amblyopia services at a tertiary pediatric hospital in Canada.
abstract: OBJECTIVE
  To evaluate whether socioeconomic status is associated with equal utilization of amblyopia services at The Hospital for Sick Children (SickKids), a pediatric tertiary hospital in Canada.
  
  
  METHODS
  This is a retrospective, cross-sectional study.
  
  
  METHODS
  The medical records of children aged under 7 years diagnosed with amblyopia at SickKids from 2007 to 2009 were reviewed.
  
  
  METHODS
  Socioeconomic status was derived from patients' residential postal codes through linking with income data in the 2006 Canadian census report. Patients were divided into 5 income quintiles to compare with amblyopia service utilization. The main outcome measure was the observed distribution of amblyopia patients by socioeconomic status versus the expected distribution of 20% for each quintile.
  
  
  RESULTS
  The analyses included 336 patients. Children with amblyopia at SickKids were more likely to come from the richest neighbourhood (32.5%), whereas children from each of the 3 lowest quintiles (14.6%-15.5%) were less likely to present at SickKids. These results differed significantly from the expected 20% for each quintile (p < 0.0001). All types of amblyopia were significantly under-represented for children from the lower socioeconomic groups. When analyses were stratified by travel distance to the hospital, a significant inequality between the lower and higher income quintiles remained for nonmetropolitan Toronto patients, but not for metropolitan Toronto patients.
  
  
  CONCLUSIONS
  Despite a publicly funded health-care system in Canada, children from lower socioeconomic neighbourhoods in distant areas utilize the amblyopia services in a tertiary pediatric centre less often than those from higher socioeconomic status.
authors.affiliation: Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ont. Electronic address: asharma.w@gmail.com.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ont; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.
authors.forename: Agnes M F
authors.initials: AM
authors.lastname: Wong
authors.affiliation: Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ont.
authors.forename: Linda
authors.initials: L
authors.lastname: Colpa
authors.affiliation: School of Optometry, University of Waterloo, Waterloo, Ont.
authors.forename: Amy H Y
authors.initials: AH
authors.lastname: Chow
authors.affiliation: Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont; Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.
authors.forename: Ya-Ping
authors.initials: YP
authors.lastname: Jin
mesh_terms: D000550:Amblyopia / Q000628:therapy*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics; D006776:Hospitals, Pediatric; D006801:Humans; D007182:Income; D007223:Infant; D008297:Male; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data; D009988:Orthoptics / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012189:Retrospective Studies; D012923:Social Class; D062606:Tertiary Care Centers