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Am J Prev Med. 2015 Aug;49(2):161-71. doi: 10.1016/j.amepre.2015.02.018. Epub 2015 May 8.

Looking Beyond Income and Education: Socioeconomic Status Gradients Among Future High-Cost Users of Health Care.

Author information

  • 1Public Health Ontario.
  • 2Public Health Ontario; Institute for Clinical Evaluative Sciences; Dalla Lana School of Public Health. Electronic address: laura.rosella@utoronto.ca.
  • 3Institute for Clinical Evaluative Sciences.
  • 4Healthy Debate; St Michael's Hospital.
  • 5St Michael's Hospital; Centre for Research on Inner City Health.
  • 6Public Health Ontario; Dalla Lana School of Public Health.
  • 7Public Health Ontario; Institute for Clinical Evaluative Sciences; Dalla Lana School of Public Health; Institute of Health Management Policy and Evaluation, University of Toronto.
  • 8Institute for Clinical Evaluative Sciences; Institute of Health Management Policy and Evaluation, University of Toronto; Toronto Rehabilitation Institute, Toronto, Ontario, Canada.

Abstract

INTRODUCTION:

Healthcare spending occurs disproportionately among a very small portion of the population. Research on these high-cost users (HCUs) of health care has been overwhelmingly cross-sectional in nature and limited to the few sociodemographic and clinical characteristics available in health administrative databases. This study is the first to bridge this knowledge gap by applying a population health lens to HCUs. We investigate associations between a broad range of SES characteristics and future HCUs.

METHODS:

A cohort of adults from two cycles of large, nationally representative health surveys conducted in 2003 and 2005 was linked to population-based health administrative databases from a universal healthcare plan for Ontario, Canada. Comprehensive person-centered estimates of annual healthcare spending were calculated for the subsequent 5 years following interview. Baseline HCUs (top 5%) were excluded and healthcare spending for non-HCUs was analyzed. Adjusted for predisposition and need factors, the odds of future HCU status (over 5 years) were estimated according to various individual, household, and neighborhood SES factors. Analyses were conducted in 2014.

RESULTS:

Low income (personal and household); less than post-secondary education; and living in high-dependency neighborhoods greatly increased the odds of future HCUs. After adjustment, future HCU status was most strongly associated with food insecurity, personal income, and non-homeownership. Living in highly deprived or low ethnic concentration neighborhoods also increased the odds of becoming an HCU.

CONCLUSIONS:

Findings suggest that addressing social determinants of health, such as food and housing security, may be important components of interventions aiming to improve health outcomes and reduce costs.

Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

PMID:
25960393
[PubMed - indexed for MEDLINE]
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