Abstract
Introduction: Previous research has shown that the socioeconomic status
(SES)-health gradient also extends to high-cost patients; however, little
work has examined high-cost patients with mental illness and/or
addiction. The objective of this study was to examine associations
between individual-, household-, and area-level SES factors and future
high-cost use among these patients.
Methods: We linked survey data from adult participants (ages 18 and
older) of three cycles of the Canadian Community Health Survey (CCHS)
to administrative health care data from Ontario, Canada. Respondents
with mental illness and/or addiction were identified based on prior
mental health and addiction health care use and followed for 5 years for
which we ascertained health care costs covered under the public health
care system. We quantified associations between SES factors and
becoming a high-cost patient (i.e, transitioning into the top 5%) using
logistic regression models. For ordinal SES factors, such as income,
education and marginalization variables, we measured absolute and
relative inequalities using the slope and relative index of inequality.
Results: Among our sample, lower personal income (OR=2.11, 95% C.I.
[1.54, 2.88] for $0 to $14,999), lower household income (OR=2.11,
95% C.I. [1.49, 2.99] for lowest income quintile), food insecurity
(OR=1.87, 95% C.I. [1.38, 2.55]) and non-homeownership (OR=1.34,
95% C.I. [1.08, 1.66]), at the individual and household levels,
respectively, and higher residential instability (OR=1.72, 95% C.I. [1.23,
2.42] for most marginalized), at the area level, were associated with
higher odds of becoming a high-cost patient within a 5-year period.
Moreover, the inequality analysis suggests pro-high-SES gradients in
high-cost transitions.
(SES)-health gradient also extends to high-cost patients; however, little
work has examined high-cost patients with mental illness and/or
addiction. The objective of this study was to examine associations
between individual-, household-, and area-level SES factors and future
high-cost use among these patients.
Methods: We linked survey data from adult participants (ages 18 and
older) of three cycles of the Canadian Community Health Survey (CCHS)
to administrative health care data from Ontario, Canada. Respondents
with mental illness and/or addiction were identified based on prior
mental health and addiction health care use and followed for 5 years for
which we ascertained health care costs covered under the public health
care system. We quantified associations between SES factors and
becoming a high-cost patient (i.e, transitioning into the top 5%) using
logistic regression models. For ordinal SES factors, such as income,
education and marginalization variables, we measured absolute and
relative inequalities using the slope and relative index of inequality.
Results: Among our sample, lower personal income (OR=2.11, 95% C.I.
[1.54, 2.88] for $0 to $14,999), lower household income (OR=2.11,
95% C.I. [1.49, 2.99] for lowest income quintile), food insecurity
(OR=1.87, 95% C.I. [1.38, 2.55]) and non-homeownership (OR=1.34,
95% C.I. [1.08, 1.66]), at the individual and household levels,
respectively, and higher residential instability (OR=1.72, 95% C.I. [1.23,
2.42] for most marginalized), at the area level, were associated with
higher odds of becoming a high-cost patient within a 5-year period.
Moreover, the inequality analysis suggests pro-high-SES gradients in
high-cost transitions.
| Original language | English |
|---|---|
| Pages (from-to) | 140-152 |
| Number of pages | 13 |
| Journal | Canadian journal of psychiatry-Revue canadienne de psychiatrie |
| Volume | 67 |
| Issue number | 2 |
| Early online date | 1 Apr 2021 |
| DOIs | |
| Publication status | Published - 1 Feb 2022 |