Suchergebnisse

Public housing, a form of low income housing, is owned and managed by government. The goal of this research was to use linked population-based administrative databases to examine the associations among public housing and sociodemographic characteristics, health, healthcare use, and residential mobility. Four related studies were undertaken. The first study determined the factors associated with applying to public housing. A cohort who applied in 2005 and 2006 was matched to a general population cohort. Individuals who applied tended to be in poorer health and were more frequent healthcare users compared to individuals with similar socioeconomic characteristics from the general population. The second study tested the factors associated with moving out of public housing, while accounting for tenancy length. A cohort who moved in 2007 and 2008 was followed for seven years. Three groups were identified; voluntary movers, evicted movers, and non-movers. Socioeconomic characteristics of the cohort were associated with moving out voluntarily. Health and healthcare use were associated with eviction. The third study describes healthcare use patterns in a cohort who moved into public housing in 2009 and 2010. Healthcare use was measured before and after the move-in date and the difference was tested. In general, there was an increase in use approximately three months before the move-in date and a decrease three months after. After this, use returned to pre-move-in levels. The fourth study tested whether changes in healthcare use are unique to public housing residents. A cohort who moved into public housing in 2012 and 2013 was matched to a general population cohort and a move-in date was randomly assigned. Different types of healthcare use were measured before and after the move-in date. The public housing cohort used healthcare services more frequently. For most healthcare measures, changes in use were similar between the two cohorts. This research demonstrates that public housing is used by low income individuals who ...

BackgroundUnder the National Housing Strategy, the Canadian government will make historic investments in housing over the next decade. The Canadian Mortgage and Housing Corporation is leading a research strategy to evaluate the impact of these investments. As part of this initiative, the Manitoba Center for Health Policy is conducting a pilot study to determine whether administrative data can be used to assess impacts, specifically looking at health, education and involvement in the justice system.
ApproachUsing administrative data we tested for changes in healthcare use and justice involvement in the two years before and after a cohort of individuals moved into public housing. Additionally, to determine if changes in the outcomes over time were unique to public housing, we included a matched comparison group of individuals who did not reside in public housing. GLM with generalized estimating equations tested for differences over time and between cohorts in the number of hospitalizations, inpatient days, emergency department visits, and contacts with the criminal justice system. The data were modeled using a Poisson distribution (rate ratio, RR).
Results Compared to the matched cohort, individuals accepted into public housing showed a significant decline in number of hospitalizations (pre RR=1.58 (1.53, 1.63), post RR=1.23 (1.19, 1.27), days in hospital (pre RR=1.66 (1.64, 1.68), post RR=1.24 (1.23, 1.26) and visits to the emergency department (pre RR=1.57 (1.52, 1.62), post RR=1.42 (1.38, 1.47). A trend towards fewer involvements with the criminal justice system was also observed (pre RR=1.37 (1.32, 1.43), post RR=1.28 (1.22, 1.34). No significant differences were noted for total respiratory morbidity or high school grades.
ConclusionAdministrative data show good potential to be used for the evaluation of public housing impacts on a wide range of health and social outcomes. Additional indicator comparisons will be reported at the conference.

IntroductionPublic housing is a form of subsidized housing that is owned and/or managed by government. Previous research suggests that public housing has a positive impact on personal finances and education outcomes, but less is known about if/how it impacts health and healthcare use.
Objectives and ApproachUsing linked administrative health and social data, we tested for changes in healthcare use among a cohort who moved into public housing in 2012 and 2013 in Manitoba, Canada, and compared utilization to a matched general population cohort who did not move into public housing. Generalized linear models with generalized estimating equations tested for differences in numbers of healthcare contacts in the years before and after the move-in date, adjusted for economic, residential mobility, and health characteristics. The data were modeled using a Poisson (rate ratio, RR), negative binomial (incident rate ratio, IRR), or a binomial (odds ratio, OR) distribution.
ResultsThere were 2619 residents in the public housing cohort; 99.7% were matched to the general population. The cohort by time interaction was statistically significant for inpatient days (p
Conclusion/ImplicationsPublic housing residents were more likely to use healthcare services than the matched population, but changes in use were similar in the two cohorts. There is little evidence that public housing impacts healthcare use, but it serves an important function of meeting basic needs for a vulnerable population group.

ABSTRACT
ObjectivePublic housing residents, who live in low income government rental housing, are often in poorer health than the rest of the population. However, few studies have been able to untangle the relationships between health and public housing residency, and to assess whether health contributes to the decision to apply. We used linked population-based administrative data from one Canadian province to compare the health and health service use of people who applied to public housing to that of people who did not apply.
ApproachAdministrative data housed in the Manitoba Centre for Health Policy's Population Health Research Data Repository were used to identify a cohort of individuals who applied to public housing in 2005 and 2006. They were matched one-to-one to a cohort from the general population using socio-demographic variables. A population registry provided demographic and geographic characteristics. Economic measures included receipt of income assistance and an area-level measure from the Statistics Canada Census. Measures of health and health service use were derived from hospital, physician, emergency department, and prescription drug databases. Conditional logistic regression was used to test the association between a public housing application and health status and health service use, after controlling for income.
ResultsThere were 10,324 individuals in each of the public housing applicant and matched cohorts; the majority were female (72.4%), young (62% less than 40 years), urban residents (61.2%), and received income assistance (52.8%). A higher percent of the public housing applicant cohort had physician-diagnosed physical and mental health conditions and used more health services compared to the matched cohort. Having a physician-diagnosed respiratory illness (odds ratio [OR] = 1.14, 95% confidence interval [CI] 1.05,1.25), diabetes (OR = 1.24, 95% CI 1.09,1.40), schizophrenia (OR = 1.58, 95% CI 1.30,1.92), affective disorders (OR = 1.37, 95% CI 1.27,1.48), and substance abuse disorders (OR = 1.46, 95% CI 1.25,1.71) were associated with an increased likelihood of applying for public housing, while being diagnosed with cancer (OR = 0.76, 95% CI 0.61,0.96) was associated with a decreased likelihood of applying, after controlling for income differences. High health service users were also more likely to apply for public housing, after controlling for income differences.
ConclusionIndividuals who move into public housing are in poor health before they apply. Health and social service supports that are co-located with public housing facilities may help to ensure that residents have successful tenancies.

Abstract Background Residence in public housing, a subsidized and managed government program, may affect health and healthcare utilization. We compared healthcare use in the year before individuals moved into public housing with usage during their first year of tenancy. We also described trends in use. Methods We used linked population-based administrative data housed in the Population Research Data Repository at the Manitoba Centre for Health Policy. The cohort consisted of individuals who moved into public housing in 2009 and 2010. We counted the number of hospitalizations, general practitioner (GP) visits, specialist visits, emergency department visits, and prescriptions drugs dispensed in the twelve 30-day intervals (i.e., months) immediately preceding and following the public housing move-in date. Generalized linear models with generalized estimating equations tested for a period (pre/post-move-in) by month interaction. Odds ratios (ORs), incident rate ratios (IRRs), and means are reported along with 95% confidence intervals (95% CIs). Results The cohort included 1942 individuals; the majority were female (73.4%) who lived in low income areas and received government assistance (68.1%). On average, the cohort had more than four health conditions. Over the 24 30-day intervals, the percentage of the cohort that visited a GP, specialist, and an emergency department ranged between 37.0% and 43.0%, 10.0% and 14.0%, and 6.0% and 10.0%, respectively, while the percentage of the cohort hospitalized ranged from 1.0% to 5.0%. Generally, these percentages were highest in the few months before the move-in date and lowest in the few months after the move-in date. The period by month interaction was statistically significant for hospitalizations, GP visits, and prescription drug use. The average change in the odds, rate, or mean was smaller in the post-move-in period than in the pre-move-in period. Conclusions Use of some healthcare services declined after people moved into public housing; however, the decrease was only observed in the first few months and utilization rebounded. Knowledge of healthcare trends before individuals move in are informative for ensuring the appropriate supports are available to new public housing residents. Further study is needed to determine if decreased healthcare utilization following a move is attributable to decreased access.

ABSTRACT
ObjectiveFourteen years of social housing data (1995-2008) were acquired from the provincial government. This allowed for an unprecedented opportunity to describe the population of individuals living in social housing and, through data linkage, to compare them to the rest of the province on a number of health and social indicators.
ApproachUsing data from the entire population of the province of Manitoba, Canada, cross-sectional comparison were made between those living in social housing and those not on 19 indicators of morbidity, mortality, health care utilization and social development. Regression models were developed to control for age, sex, region of residence, comorbidities, income and neighborhood level SES.
Results50% of the population in social housing are under the age 20, 75% are female and 50% of applicants receive some form of income assistance. As expected there are significant differences on most health status measures when compared to individuals not in social housing. However, after controlling for confounding factors most differences between the two groups disappear indicating that there is no independent effect of living in social housing. A few exceptions were noted on measures of total respiratory morbidity, mammography and high school completion rates, the later showing a very significant interaction with neighborhood level SES.
ConclusionDespite overall poor health status, after controlling for income and other confounding factors individuals in social housing score no worse on many measures of health care utilization and prevention. High school completion rates, in particular, showed a very strong interaction with neighborhood level SES. Policy implications of this research are discussed.

IntroductionEarly education outcomes influence children's educational trajectories with long-term effects extending into adulthood. Aboriginal peoples face numerous systemic barriers to academic success. It remains unknown if full-day kindergarten (FDK) is associated with improved academic outcomes among Metis children – a distinct Aboriginal people recognized by the Canadian Constitution.
Objectives and ApproachThe Manitoba Metis Federation and the Manitoba Centre for Health Policy partnered to identify whether FDK was associated with improved short- and long-term outcomes among Metis children. We created a cohort of Metis children by linking several provincial databases held in the Manitoba Population Research Data Repository (1998-2011). Education data were used to identify all Metis children who attended FDK (n=247) vs half day kindergarten (HDK; n=547). FDK children were matched by age and sex to children in HDK. We used a step-wedged design and applied propensity scores to adjust for measured confounding. We tested for differences in grades 3, 7, 8 outcomes and high school graduation using generalized linear models.
ResultsFDK children were more likely to live in a low-income neighbourhood. 72% FDK and 74% HDK students met or approached numeracy expectations in grade 3; and 55% FDK and 48% HDK met or approached numeracy expectations in grade 7. For reading expectations, 77% FDK and 75% HDK met or approached grade 3 reading expectations; in grade 8, 62% in each group met or approached expectations for reading and writing. High school graduation rate for FDK children was 84% and for HDK children was 64%. After adjusting for confounding we found FDK children were more likely to graduate high school than HDK children; other outcomes were non-significant.
Conclusion / ImplicationsKindergarten programs may be insufficient to overcome structural barriers that Metis children face. Culturally appropriate education strategies are needed to support improved outcomes amongst this population.

IntroductionIn Manitoba, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit (HBPB), a prenatal income supplement. Research has demonstrated positive outcomes associated with HBPB, but it remains unknown if Metis women and children – who are of mixed European and Aboriginal descent and one of the most marginalized populations in Canada -- benefit from the program.
Objectives and ApproachThe Manitoba Metis Federation and the Manitoba Centre for Health Policy partnered to determine the impact of HBPB on Metis newborn and early childhood outcomes. We included all Metis women giving birth in Manitoba 2003-2011 who received income assistance during pregnancy (n=4,852), adjusting for differences between those receiving (n=3,681) and not receiving (n=1,171) HBPB with propensity score weighting. We used multi-variable regressions to compare outcomes between groups: breastfeeding initiation, low birth weight, preterm birth, small- and large-for-gestational age, Apgar scores, birth hospitalization length of stay (LOS), neonatal readmissions, infant hospitalizations, vaccinations at age 1 and 2, and child development scores at kindergarten.
ResultsHBPB receipt was associated with reductions in low birth weight (adjusted Relative Risk (aRR): 0.74 (95% CI: 0.58-0.94)) and preterm births (aRR: 0.78 (0.65-0.94)), and increases large-for-gestational age births (aRR: 1.21 (1.06-1.39)) and neonatal readmissions (aRR: 1.58 (1.05-2.37)). Birth hospitalization LOS was lower for newborns whose mothers received HBPB (Mean Difference 0.29 days). HBPB was associated with increases in vaccinations for children aged 1 (aRR: 1.08 (1.00-1.15)) and 2 (aRR: 1.12 (1.05-1.18)). No significant associations were found for small-for-gestational age births, Apgar scores, breastfeeding initiation, infant hospitalizations or child development scores.
Conclusion / ImplicationsA modest unconditional prenatal income supplement to low-income Metis women was associated with improved birth outcomes and child vaccinations; however, an association with increased neonatal readmissions warrants further exploration. Lack of significant associations between HBPB and child development measures suggests more sustained support may be necessary to improve longer-term outcomes.

This study, a partnership between <Organization 1> and <Organization 2>, investigated whether attending full-time kindergarten (FTK) was associated with better educational outcomes for Metis students in Manitoba, who may face unique barriers to academic success. We utilized linked administrative data from the Manitoba Population Research Data Repository. For each measured education outcome, there were no significant differences in how Metis students who attended FTK vs Metis students who attended half-time kindergarten (HTK) performed. FTK does not provide sufficient support to Metis students to overcome the structural barriers to academic success they may face. It is likely that an upstream approach to addressing the structural barriers is needed to support improved outcomes in this population.