Risk factors for avoidable hospitalizations in Canada using national linked data: A retrospective cohort study

Abstract

Hospitalizations for certain chronic conditions are considered avoidable for adult Canadians given effective and timely primary care management. Individual-level risk factors such as income and health behaviours are not routinely collected in most hospital databases and as a result, are largely uncharacterized for avoidable hospitalization at the national level. The aim of this study was to identify and describe demographic, socioeconomic, and health behavioural risk factors for avoidable hospitalizations in Canada using linked data. A national retrospective cohort study was conducted by pooling eight cycles of the Canadian Community Health Survey (2000/2001-2011) and linking to hospitalization records in the Discharge Abstract Database (1999/2000-2012/2013). Respondents who were younger than 18 years and older than 74 years of age, residing in Quebec, or pregnant at baseline were excluded yielding a final cohort of 389,065 individuals. The primary outcome measure was time-to index avoidable hospitalization. Sex-stratified Cox proportional hazard models were constructed to determine effect sizes adjusted for various factors and their associated 95% confidence intervals. Demographics, socioeconomic status, and health behaviours are associated with risk of avoidable hospitalizations in males and females. In fully adjusted models, health behavioural variables had the largest effect sizes including heavy smoking (Male HR 2.65 (95% CI 2.17-3.23); Female HR 3.41 (2.81-4.13)) and being underweight (Male HR 1.98 (1.14-3.43); Female HR 2.78 (1.61-4.81)). Immigrant status was protective in both sexes (Male HR 0.83 (0.69-0.98); (Female HR 0.69 (0.57-0.84)). Adjustment for behavioural and clinical variables attenuated the effect of individual-level socioeconomic status. This study identified several risk factors for time-to-avoidable hospitalizations by sex, using the largest national database of linked health survey and hospitalization records. The larger effect sizes of several modifiable risk factors highlights the importance of prevention in addressing avoidable hospitalizations in Canada.

Cumulative social disadvantage and hospitalisations due to ambulatory care-sensitive conditions in Finland in 2011─2013: a register study

“…De Prophetis et al 17 detected that the risk of being hospitalised due to ACSCs was highest for those who jointly had the lowest levels of life satisfaction and low household income. The study by Wallar and Rosella 18 saw that individuals among the two lowest income quintiles were at greatest risk of being hospitalised due to ACSCs when adjusting for education and health behavioural factors. However, these studies did not examine how the accumulation of individual-level socioeconomic risk factors affects the risk of being hospitalised due to ACSCs.…”

“…Earlier studies have used slightly different lists of conditions, but have usually examined three types of conditions: conditions that can be prevented by vaccination, acute conditions in which hospitalisation can be prevented by adequate (acute) management of the condition, and chronic conditions where good quality and timely primary care can prevent later admissions, for example, due to complications of diabetes. Several studies from the USA, [11][12][13] Canada, [14][15][16][17][18] Australia, [19][20][21] New Zealand 22 and European countries [23][24][25][26][27][28][29] have examined socioeconomic differences in ACSC and reported more ACSC hospitalisations among persons with lower socioeconomic background.…”

“…One study, which examined elderly Medicare beneficiaries in the USA, and another study from Ontario, Canada, utilising survey data linked to administrative databases, used multiple individual-level indicators of socioeconomic position but they did not examine them simultaneously. 11 17 A study from Stockholm County in Sweden 26 and a study from Canada 18 analysed several individual-level socioeconomic variables simultaneously. Additionally, a study from Ontario, Canada, examined trends and regional differences in acute diabetes complications and accounted for income and education at the community level.…”

Social inequalities, length of hospital stay for chronic conditions and the mediating role of comorbidity and discharge destination: A multilevel analysis of hospital administrative data linked to the population census in Switzerland

“…There is also broad evidence of social differences in the use of inpatient medical services. Those with a low education level (3)(4)(5), low health literacy (6), a low income (5,7) or limited social support (3,4,8,9) are at higher risk for hospitalisation due to chronic conditions, while lower hospitalisation risks have been reported for those with a migration background (5). Socially disadvantaged persons show elevated hospitalisation risks particularly for ambulatory care sensitive conditions (ACSC) such as diabetes, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and asthma (3,5,7).…”

“…Those with a low education level (3)(4)(5), low health literacy (6), a low income (5,7) or limited social support (3,4,8,9) are at higher risk for hospitalisation due to chronic conditions, while lower hospitalisation risks have been reported for those with a migration background (5). Socially disadvantaged persons show elevated hospitalisation risks particularly for ambulatory care sensitive conditions (ACSC) such as diabetes, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and asthma (3,5,7). Hospital stays for ACS-conditions resulting from an acute deterioration in health can often be avoided with effective ambulatory care, patient compliance and self-management (5,10).…”