Understanding intersectional inequality in access to primary care providers using multilevel analysis of individual heterogeneity and discriminatory accuracy.

Autor: He JW; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.; Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada., Terry AL; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.; Department of Family Medicine, Western University, London, Ontario, Canada., Lizotte D; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.; Department of Computer Science, Western University, London, Ontario, Canada., Bauer G; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.; Institute for Sexual and Gender Health, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America., Ryan BL; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.; Department of Family Medicine, Western University, London, Ontario, Canada.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Jan 19; Vol. 19 (1), pp. e0296657. Date of Electronic Publication: 2024 Jan 19 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0296657
Abstrakt: Background: Despite the Canadian healthcare system's commitment to equity, evidence for disparate access to primary care (PC) providers exists across individual social identities/positions. Intersectionality allows us to reflect the realities of how social power shapes healthcare experiences at an individual's interdependent and intersecting social identities/positions. The objectives of this study were to determine: (1) the extent to which intersections can be used classify those who had/did not have a PC provider; (2) the degree to which each social identity/position contributes to the ability to classify individuals as having a PC provider; and (3) predicted probabilities of having a PC provider for each intersection.
Methods and Findings: Using national cross-sectional data from 241,445 individuals in Canada aged ≥18, we constructed 320 intersections along the dimensions of gender, age, immigration status, race, and income to examine the outcome of whether one had a PC provider. Multilevel analysis of individual heterogeneity and discriminatory accuracy, a multi-level model using individual-level data, was employed to address intersectional objectives. An intra-class correlation coefficient (ICC) of 23% (95%CI: 21-26%) suggests that these intersections could, to a very good extent, explain individual variation in the outcome, with age playing the largest role. Not all between-intersection variance in this outcome could be explained by additive effects of dimensions (remaining ICC: 6%; 95%CI: 2-16%). The highest intersectional predicted probability existed for established immigrant, older South Asian women with high income. The lowest intersectional predicted probability existed for recently immigrated, young, Black men with low income.
Conclusions: Despite a "universal" healthcare system, our analysis demonstrated a substantial amount of inequity in primary care across intersections of gender, age, immigration status, race, and income.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 He et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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