Regional Variations in Care Linked to Heart Attack and Stroke Risk

Despite Canada’s universal health insurance system, the use of certain preventive health services differs significantly between Ontario’s local health integration networks (LHINs). This difference accounts for about 15% of the difference in heart disease events—including heart attack, stroke and deaths from heart disease—between the areas, according to a new study.

Researchers from the Canadian Cardiovascular Health in Ambulatory Care Research Team looked at data from 5.5 million Ontarians aged 40 to 79 who had never had a hospital stay for heart disease at the start of the study.

Over five years, cardiovascular event rates varied almost twofold between the LHINs with the highest and lowest rates. Although people living in LHINs with high event rates were more likely to be obese, to smoke and to eat fewer fruits and vegetables, they were also less likely to see a doctor regularly, to be screened for heart disease and to keep cholesterol and blood pressure within target limits.

“The lower numbers of [doctor] visits may reflect differences in health-seeking behaviour between residents of different LHINs, but they may also reflect differences in access to care,” including the challenges Ontario has experienced recruiting and retaining primary care physicians to northern and more rural parts of the province, wrote the study authors.