Air pollution and general practitioner access and utilization: a population based study in Sarnia, 'Chemical Valley,' Ontario

Abstract

BackgroundHealth impacts of poor environmental quality have been identified in studies around the world and in Canada. While many of the studies have identified associations between air pollution and mortality or morbidity, few have focused on the role of health care as a potential moderator of impacts. This study assessed the determinants of health care access and utilization in the context of ambient air pollution in Sarnia, Ontario, Canada.MethodsResidents of Sarnia participated in a Community Health Study administered by phone, while several ambient air pollutants including nitrogen dioxide (NO2), sulphur dioxide (SO2) and the volatile organic compounds benzene, toluene, ethylbenzene, mp- and o-xylene (BTEX) were monitored across the city. Land Use Regression models were used to estimate individual exposures to the measured pollutants and logistic regression models were utilized to assess the relative influence of environmental, socioeconomic and health related covariates on general practitioner access and utilization outcomes.ResultsThe results show that general practitioner use increased with levels of exposure to nitrogen dioxide (NO2- Odds Ratio [OR]: 1.16, p < 0.05) and sulphur dioxide (SO2- OR: 1.61, p < 0.05). Low household income was a stronger predictor of having no family doctor in areas exposed to high concentrations of NO2 and SO2. Respondents without regular care living in high pollution areas were also more likely to report travelling or waiting for care in excess of 20 minutes (OR: 3.28, p < 0.05) than their low exposure counterparts (OR: 1.11, p > 0.05).ConclusionsThis study provides evidence for inequitable health care access and utilization in Sarnia, with particular relevance to its situation as a sentinel high exposure environment. Levels of exposure to pollution appears to influence utilization of health care services, but poor access to primary health care services additionally burden certain groups in Sarnia, Ontario, Canada.

Association between Air Pollution and General Outpatient Clinic Consultations for Upper Respiratory Tract Infections in Hong Kong

“… [12] Oiamo et al used a community health survey on GP access and utilisation in Sarnia, Ontario, in Canada, and data on spatial differences in air pollutant concentrations, to demonstrate their relationships. [32] A time series study that took place over the 2008 Olympic Games in Beijing showed a significant reduction in outpatient visits for asthma during the air pollution control period, during which traffic and industrial emissions were restricted. [33] This provided strong evidence of a cause-effect relationship between air pollution and respiratory illnesses in an outpatient setting.…”

Assessing the spatial distribution of nitrogen dioxide in London, Ontario

“…Two expressways transect London, but they are located at the southern periphery of residential settlement. The city's location within the most industrialized region of Canada and proximity to cities like Sarnia and Windsor with documented air pollution health problems (Oiamo et al, 2011;Luginaah et al, 2005) are causes of concern to local residents, officials, and public health professionals. London is located in the busiest trade corridor between the United States and Canada, as well as downwind from point sources such as oil refineries, steel mills, and coal plants in Michigan and southwestern Ontario.…”

A geographical analysis of breast cancer clustering in southern Ontario: generating hypotheses on environmental influences

“…Brophy et al 2006;Fung et al 2007). Numerous studies have demonstrated the presence of high air pollution concentrations due to local and regional pollution sources, notably industrial emissions, and their impact on health in Lambton and Essex counties (Burnett et al 1998;Atari et al 2008;Atari and Luginaah 2009;Oiamo et al 2011). These counties are well known for environmental exposure problems as a result of the proximity to Chemical Valley and several transboundary exposure sources along the Canada-US border and around the Great Lakes Region (Health Canada 2000; Gilbertson and Broophy 2001;Mackenzie et al 2005).…”