Academic journal article Canadian Journal of Public Health

Health Disparities in Chickenpox or Shingles in Alberta?

Academic journal article Canadian Journal of Public Health

Health Disparities in Chickenpox or Shingles in Alberta?

Article excerpt

ABSTRACT

Objective: Exploring for evidence of socio-economic health disparities in chickenpox and shingles in Alberta, Canada.

Methods: Chickenpox and shingles cases were identified from administrative data from Alberta's universal health care insurance system for 1994-2002. Incident cases were those with the earliest dated utilization of a health service (chickenpox: ICD9-CM 052/ICD10-CA B01; shingles: ICD9-CM 053/ICD10-CA B02). Crude and age-specific rates were estimated for each year by an indicator of socio-demographic status based upon the nature of the payer and eligibility for health care premium subsidy (SES-proxy) for the provincial health care insurance system.

Results: Among young children there is a gradient of disparity in chickenpox rates prior to the year in which publicly funded vaccination programs were implemented. After this point, disparities decline but less so for First Nations children than for others. There was no evidence of disparity by SES-proxy for shingles.

Conclusion: Publicly funded vaccination programs may effectively contribute to reduction in disease disparities for vaccine-preventable diseases. Further study is required to ascertain why disparities continue for First Nations children.

Key words: Herpes zoster; chickenpox; Canada; population surveillance; social class; income; Indians, North American

Canadians of lower socio-economic status (SES) and Aboriginal identity are known to incur health disparities.1,2 These include elevated rates of some vaccine-preventable diseases (e.g., pertussis, rubella) among Aboriginal peoples.3

Varicella vaccine was licensed in Canada in 1998, and Alberta initiated a publicly funded vaccination program in April, 2001. Starting in 2001, Health Canada - First Nations & Inuit Health Branch Alberta Region implemented a funded varicella vaccination program within their routine immunization program which paralleled the provincial program (personal communication, Ruth Richardson, Regional CDC Nurse Manager Health Canada FNIHB, Alberta Region, August 8, 2006). We explore for evidence of disparities in the occurrence of varicella (chickenpox) and varicella zoster (shingles) in Alberta, using administrative data from Alberta's universal, publicly funded health care insurance system for the period 1994 2002. There are few data addressing disparities (especially for Aboriginal peoples) related to these diseases.

METHODS

Over 99% of Alberta's 3 million residents are covered by the provincial health care insurance plan. Information on each insured person is maintained in a provincial registration file which includes demographic information as well as a unique lifetime personal health number (PHN) which can be used to link the registration file to a variety of health data sources. Alberta collects a health care insurance premium on a quarterly basis; therefore the accuracy of the registry is maintained during inter-censal periods.4 Health Canada is responsible for the payment of these premiums for First Nations treaty-status Aboriginals. Therefore, this status is tracked by Alberta Health and Wellness and an indicator of treaty status can be created. 5 The premiums for all individuals on social services are paid by the government, which permits social service status to be tracked and an indicator formed by Alberta Health and Wellness. For all other Albertans, the registry includes whether or not the person is eligible for health care premium subsidy based upon taxable family income from the previous calendar year. All of this information was used to create a single socio-economic status indicator variable (SES-proxy) with 4 mutually exclusive categories (Table I) that are useful for persons aged less than 65 years (the government of Alberta waives the premium for persons aged 65 or older). We used the PHN for deterministic linkage between the registry, the electronic fee-for-service data system and the Hospital Morbidity Inpatient Database to identify incident cases of chickenpox and shingles. …

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