Health status and healthcare use patterns of rural, northern and urban Manitobans: is Romanow right?

OBJECTIVE To compare health status and healthcare services use of rural, northern and urban Manitobans. METHOD Using anonymized administrative claims data derived from the Population Health Research Data Repository housed at the Manitoba Centre for Health Policy, four Manitoba regions were compared--Winnipeg, Brandon, Rural South and North--for 1996/97-2000/01. Indicators include mortality and morbidity, ambulatory physician visit and specialist consultation rates, prevention/screening rates, selected surgery rates (cardiac catheterization, coronary artery bypass graft surgery, hip replacement) and "discretionary" surgery rates (tonsillectomy/adenoidectomy, Caesarean section, hysterectomy). Rates were annualized, directly standardized to the 1996 provincial population, and statistically tested for differences among the regions using Hotelling's T(2) statistic. RESULTS Mortality and morbidity are high in the North, but the Rural South is average (except for high rates of injury mortality and stroke). Rural South and North have low ambulatory physician visits and specialist consultation rates, but high hospitalization rates compared to Brandon and Winnipeg. In prevention/screening rates, Rural South is variable and the North is low. For surgery rates, Rural South is variable, North is average, Brandon has below-average surgical rates but high rates of discretionary procedures, and Winnipeg has high surgical rates but low discretionary procedures. Thus, "urban" is not necessarily synonymous with good health and better access to services, nor is "rural" or "remote" synonymous with poor health and inadequate healthcare.