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Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data
BACKGROUND: This study explores how socio-demographic and health factors shape the relationship between multimorbidity and one-year acute care service use (i.e., hospital, emergency department visits) in older adults in Ontario, Canada. METHODS: We linked multiple cycles (2005–2006, 2007–2008, 2009–...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805153/ https://www.ncbi.nlm.nih.gov/pubmed/33435978 http://dx.doi.org/10.1186/s12913-020-06032-5 |
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author | Fisher, Kathryn A. Griffith, Lauren E. Gruneir, Andrea Upshur, Ross Perez, Richard Favotto, Lindsay Nguyen, Francis Markle-Reid, Maureen Ploeg, Jenny |
author_facet | Fisher, Kathryn A. Griffith, Lauren E. Gruneir, Andrea Upshur, Ross Perez, Richard Favotto, Lindsay Nguyen, Francis Markle-Reid, Maureen Ploeg, Jenny |
author_sort | Fisher, Kathryn A. |
collection | PubMed |
description | BACKGROUND: This study explores how socio-demographic and health factors shape the relationship between multimorbidity and one-year acute care service use (i.e., hospital, emergency department visits) in older adults in Ontario, Canada. METHODS: We linked multiple cycles (2005–2006, 2007–2008, 2009–2010, 2011–2012) of the Canadian Community Health Survey (CCHS) to health administrative data to create a cohort of adults aged 65 and older. Administrative data were used to estimate one-year service use and to identify 12 chronic conditions used to measure multimorbidity. We examined the relationship between multimorbidity and service use stratified by a range of socio-demographic and health variables available from the CCHS. Logistic and Poisson regressions were used to explore the association between multimorbidity and service use and the role of socio-demographic factors in this relationship. RESULTS: Of the 28,361 members of the study sample, 60% were between the ages of 65 and 74 years, 57% were female, 72% were non-immigrant, and over 75% lived in an urban area. Emergency department visits and hospitalizations consistently increased with the level of multimorbidity. This study did not find strong evidence of moderator or interaction effects across a range of socio-demographic factors. Stratified analyses revealed further patterns, with many being similar for both services – e.g., the odds ratios were higher at all levels of multimorbidity for men, older age groups, and those with lower household income. Rurality and immigrant status influenced emergency department use (higher in rural residents and non-immigrants) but not hospitalizations. Multimorbidity and the range of socio-demographic variables remained significant predictors of service use in the regressions. CONCLUSIONS: Strong evidence links multimorbidity with increased acute care service use. This study showed that a range of factors did not modify this relationship. Nevertheless, the factors were independently associated with acute care service use, pointing to modifiable risk factors that can be the focus of resource allocation and intervention design to reduce service use in those with multimorbidity. The study’s results suggest that optimizing acute care service use in older adults requires attention to both multimorbidity and social determinants, with programs that are multifactorial and integrated across the health and social service sectors. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-020-06032-5. |
format | Online Article Text |
id | pubmed-7805153 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-78051532021-01-14 Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data Fisher, Kathryn A. Griffith, Lauren E. Gruneir, Andrea Upshur, Ross Perez, Richard Favotto, Lindsay Nguyen, Francis Markle-Reid, Maureen Ploeg, Jenny BMC Health Serv Res Research Article BACKGROUND: This study explores how socio-demographic and health factors shape the relationship between multimorbidity and one-year acute care service use (i.e., hospital, emergency department visits) in older adults in Ontario, Canada. METHODS: We linked multiple cycles (2005–2006, 2007–2008, 2009–2010, 2011–2012) of the Canadian Community Health Survey (CCHS) to health administrative data to create a cohort of adults aged 65 and older. Administrative data were used to estimate one-year service use and to identify 12 chronic conditions used to measure multimorbidity. We examined the relationship between multimorbidity and service use stratified by a range of socio-demographic and health variables available from the CCHS. Logistic and Poisson regressions were used to explore the association between multimorbidity and service use and the role of socio-demographic factors in this relationship. RESULTS: Of the 28,361 members of the study sample, 60% were between the ages of 65 and 74 years, 57% were female, 72% were non-immigrant, and over 75% lived in an urban area. Emergency department visits and hospitalizations consistently increased with the level of multimorbidity. This study did not find strong evidence of moderator or interaction effects across a range of socio-demographic factors. Stratified analyses revealed further patterns, with many being similar for both services – e.g., the odds ratios were higher at all levels of multimorbidity for men, older age groups, and those with lower household income. Rurality and immigrant status influenced emergency department use (higher in rural residents and non-immigrants) but not hospitalizations. Multimorbidity and the range of socio-demographic variables remained significant predictors of service use in the regressions. CONCLUSIONS: Strong evidence links multimorbidity with increased acute care service use. This study showed that a range of factors did not modify this relationship. Nevertheless, the factors were independently associated with acute care service use, pointing to modifiable risk factors that can be the focus of resource allocation and intervention design to reduce service use in those with multimorbidity. The study’s results suggest that optimizing acute care service use in older adults requires attention to both multimorbidity and social determinants, with programs that are multifactorial and integrated across the health and social service sectors. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-020-06032-5. BioMed Central 2021-01-13 /pmc/articles/PMC7805153/ /pubmed/33435978 http://dx.doi.org/10.1186/s12913-020-06032-5 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Fisher, Kathryn A. Griffith, Lauren E. Gruneir, Andrea Upshur, Ross Perez, Richard Favotto, Lindsay Nguyen, Francis Markle-Reid, Maureen Ploeg, Jenny Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data |
title | Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data |
title_full | Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data |
title_fullStr | Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data |
title_full_unstemmed | Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data |
title_short | Effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data |
title_sort | effect of socio-demographic and health factors on the association between multimorbidity and acute care service use: population-based survey linked to health administrative data |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805153/ https://www.ncbi.nlm.nih.gov/pubmed/33435978 http://dx.doi.org/10.1186/s12913-020-06032-5 |
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