Socioeconomic status and wait times for pediatric surgery in Canada

Pediatrics. 2014 Aug;134(2):e504-11. doi: 10.1542/peds.2013-3518. Epub 2014 Jul 7.


Objectives: Even in a publicly funded health care system, access to care may be related to socioeconomic status (SES). For children, delays in surgical procedures can have profound functional, social, and psychological effects with lifelong impact. The purpose of this study was to determine whether SES was related to meeting surgical wait time access targets for children. We also assessed the effects of gender, age, and distance to hospital on meeting access targets.

Methods: Patient addresses, referral wait times, and surgical wait times were obtained for 39,287 surgical procedures between 2005 and 2011 at the Hospital for Sick Children. Using census data, we derived household income quintile, distance to hospital, and indices of social and material deprivation. These indices were correlated with the percentage of children meeting clinic referral wait time targets and receiving surgery within the Pediatric Canadian Access Targets for Surgery.

Results: Across all SES quintiles, 33% of children exceeded their referral wait time targets, and 28% of children exceeded their surgical wait time targets. Indices of material or social deprivation and age did not correlate with the time from referral to clinic consultation (P = .54, .40, and .58, respectively). Gender was statistically significant (P < .001), but the difference was small (odds ratio = 0.87 for girls). Distance was also statistically significant (P = .005), and these differences translate into clinically meaningful differences in meeting wait time targets. Regarding completion of surgical procedures, material deprivation, distance, and gender did not correlate with longer wait times for surgery (P = .44, .09, .59, respectively). Social deprivation was statistically significant (P = .02) but not clinically significant. Increasing patient age was significantly associated with increased proportion of out-of-window wait times (P < .001). SES did not affect the timeliness of completion of surgery even when the urgency of the surgery (priority level based on diagnosis) was considered.

Conclusions: SES does not predict the timeliness of delivery for pediatric surgical services.

Keywords: access targets; equal access health care; health care delivery; pediatric surgery; publicly funded health care; socioeconomic status; wait times.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Canada
  • Health Services Accessibility*
  • Hospitals, Pediatric
  • Humans
  • Outcome and Process Assessment, Health Care
  • Social Class*
  • State Medicine
  • Surgical Procedures, Operative / statistics & numerical data*
  • Waiting Lists*