Ethnic Differences in Mental Health Status and Service Utilization: A Population-Based Study in Ontario, Canada

Chiu, Maria; Amartey, Abigail; Wang, Xuesong; Kurdyak, Paul

doi:10.1177/0706743717741061

Cited by 85 publications

(81 citation statements)

References 34 publications

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“…Prior Canadian investigations have shown that ethnic minorities have lower rates of health care utilization and are therefore less likely to be "high-cost users" than Caucasians, 24 particularly for mental health services. 25,26 Our finding that patients living in visible minority concentrated neighborhoods have lower odds of DBS surgery compared to those residing in predominantly Caucasian neighborhoods coincides with reported race/ethnic differences in DBS utilization for PD in the US. 8,27 Although lower use of DBS by those living in Ontario's most ethnically concentrated neighborhoods is not linked to lack of health insurance, it may in-part be explained by several factors.…”

Section: Discussionsupporting

confidence: 67%

Disparities in Deep Brain Stimulation Use for Parkinson’s Disease in Ontario, Canada

Crispo

Lam²,

Le³

et al. 2020

Can. J. Neurol. Sci.

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Objective: To examine whether sociodemographic characteristics and health care utilization are associated with receiving deep brain stimulation (DBS) surgery for Parkinson’s disease (PD) in Ontario, Canada. Methods: Using health administrative data, we identified a cohort of individuals aged 40 years or older diagnosed with incident PD between 1995 and 2009. A case-control study was used to examine whether select factors were associated with DBS for PD. Patients were classified as cases if they underwent DBS surgery at any point 1-year after cohort entry until December 31, 2016. Conditional logistic regression modeling was used to estimate the adjusted odds of DBS surgery for sociodemographic and health care utilization indicators. Results: A total of 46,237 individuals with PD were identified, with 543 (1.2%) receiving DBS surgery. Individuals residing in northern Ontario were more likely than southern patients to receive DBS surgery [adjusted odds ratio (AOR) = 2.23, 95% confidence interval (CI) = 1.15–4.34]; however, regional variations were not observed after accounting for medication use among older adults (AOR = 1.04, 95% CI = 0.26–4.21). Patients living in neighborhoods with the highest concentration of visible minorities were less likely to receive DBS surgery compared to patients living in predominantly white neighborhoods (AOR = 0.27, 95% CI = 0.16–0.46). Regular neurologist care and use of multiple PD medications were positively associated with DBS surgery. Conclusions: Variations in use of DBS may reflect differences in access to care, specialist referral pathways, health-seeking behavior, or need for DBS. Future studies are needed to understand drivers of potential disparities in DBS use.

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Section: Discussionsupporting

confidence: 67%

Disparities in Deep Brain Stimulation Use for Parkinson’s Disease in Ontario, Canada

Crispo

Lam²,

Le³

et al. 2020

Can. J. Neurol. Sci.

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“…We will also conduct subanalyses using data from CCHS 1.2 Cycle and CCHS 2012 for Mental Health, which contain validated measures for mood and anxiety disorders 34. Symptoms will be based on the following questions that have been used in previous studies45 59–64:…”

Section: Methods and Analysismentioning

confidence: 99%

Examining the effects of low back pain and mental health symptoms on healthcare utilisation and costs: a protocol for a population-based cohort study

et al. 2019

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IntroductionLow back pain (LBP) is a leading cause of disability associated with high healthcare utilisation and costs. Mental health symptoms are negative prognostic factors for LBP recovery; however, no population-based studies have assessed the joint effects of LBP and mental health symptoms on healthcare utilisation. This proposed study will characterise the health system burden of LBP and help identify priority groups to inform resource allocation and public health strategies. Among community-dwelling adult respondents of five cycles of the Canadian Community Health Survey (CCHS) in Ontario, we aim to assess the effect of self-reported LBP on healthcare utilisation and costs and assess whether this effect differs between those with and without self-reported mental health symptoms.Methods and analysisWe designed a dynamic population-based cohort study using linkages of survey and administrative data housed at ICES. The Ontario sample of CCHS (2003–2004, 2005–2006, 2007/2008, 2009/2010, 2011/2012; total of ~1 30 000 eligible respondents) will be used to define the cohort of adults with self-reported LBP with and without mental health symptoms. Healthcare utilisation and costs will be assessed by linking health administrative databases. Follow-up ranges from 6 to 15 years (until 31 March 2018). Sociodemographic (eg, age, sex, education) and health behaviour (eg, comorbidities, physical activity) factors will be considered as potential confounders. Poisson and linear (log-transformed) regression models will be used to assess the association between LBP and healthcare utilisation and costs. We will assess effect modification with mental health symptoms on the additive and multiplicative scales and conduct sensitivity analyses to assess the impact of misclassification and residual confounding.Ethics and disseminationThis study is approved by the University of Toronto Research Ethics Board. We will disseminate findings using a multifaceted knowledge translation strategy, including scientific conference presentations, publications in peer-reviewed journals and workshops with key knowledge users.

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“…However, this could be a distorted perception of the reality in Canada. In an Ontario-based study, Chiu et al (2018) discussed that there was an underutilization of mental health services by immigrant and visible minorities. As a result, this may contribute towards a lower number of reported mental illness cases in areas of higher ethnic concentration.…”

Section: Discussionmentioning

confidence: 99%

Spatio-temporal analysis of mental illness and the impact of marginalization-based factors: a case study of Ontario, Canada

Persad¹

2020

Annals of GIS

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Mental illness is a predominant medical condition in Canada. Marginalized groups in the Canadian population such as those with low income, the poorly educated and ethnic minorities are susceptible to mental health disorders. Using mental health-related emergency department visits as an indicator of mental illness cases, we employ a Bayesian spatio-temporal regression model to estimate mental illness risk across the 35 public health units of Ontario, Canada from 2006 to 2017. The association between mental illness and the following marginalization-related factors: material deprivation, residential instability and ethnic concentration is also evaluated. Over the assessed period, the relative risk of mental illness ranged from 0.45 (95% CI: 0.44-0.46) to 3.29 (95% CI: 3.20-3.37). Health units with elevated levels of material deprivation and residential instability were positively associated with increased mental illness risk whilst areas with higher ethnic concentration were linked with lower risk. Findings showed that the temporal trend of risk continuously increased over the 11 year period, with health units in northern Ontario experiencing higher risk compared to southern units. The management of psychiatric disorders presents a significant challenge to the Canadian health-care system. An understanding of the geographic distribution of mental health risk across space and time can be useful for improved policy-making and public health monitoring.

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Ethnic Differences in Mental Health Status and Service Utilization: A Population-Based Study in Ontario, Canada

Cited by 85 publications

References 34 publications

Disparities in Deep Brain Stimulation Use for Parkinson’s Disease in Ontario, Canada

Disparities in Deep Brain Stimulation Use for Parkinson’s Disease in Ontario, Canada

Examining the effects of low back pain and mental health symptoms on healthcare utilisation and costs: a protocol for a population-based cohort study

Spatio-temporal analysis of mental illness and the impact of marginalization-based factors: a case study of Ontario, Canada

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