Youth health care utilization in Nova Scotia: What is the role of age, sex and socio-economic status?

Abstract

Y outh, who experience major changes in physical, mental and social development, 1,2 have distinct and unique health care needs related to this critical transition period in their development. 3,4 These needs are often not well met within a framework that is designed either for children or adults. 5 Changes in health, including an increased burden of mental disorders, increasing autonomy and an emerging capacity for self-initiated health-seeking behaviour, are all features of the transition period from child to adult. 3 However, despite the challenges involved in delivering appropriate services to youth, little attention has been devoted to how health services are best delivered to this age group. 6 Data on youth health care utilization are published annually in the United States (US) 7-10 and elsewhere. 11 However, in Canada there is no systematic provision of such information, and published data are limited to specific subgroups 12 or chronic diseases, 13 or focused on gender-related factors. 14 Comprehensive information on patterns of health care use by youth in Canada is therefore warranted. Vingilis et al. 1 examined health care utilization rates in a longitudinal cohort of Canadian adolescents aged 12-19 years (n=1,493) from the Canadian National Population Health Survey (1994/1996). Rates of physician utilization were higher for females and for older adolescents. 1 Conversely, studies from the US suggest that family physician utilization declines with age during adolescence, although this is largely attributable to a decline in non-emergency use among males. 15 Youth tend to over-utilize emergency settings, particularly socioeconomically disadvantaged youth. 16,17 In general, US youth are under-represented in their use of family physicians, with respect to their population size, compared to children and adults. 15 Utilization of health services in the US has been shown to be lower among low income youth, 4,17 although data on socioeconomic disparities in youth health care utilization are limited in Canada. There is no specific age when youth enter the adult health care system, and the transition age range is usually patient-/provider-specific. In general, many paediatric services use age 18 or 21 years as the upper limit. 18,19 Many services in Nova Scotia use age 16 as the transition age, although this varies by condition. How to provide health care that is efficient, effective and appropriate to meet patients' needs across all age groups is a critical issue for health care systems in Canada. The challenge is to optimize delivery of resources without increasing costs, while meeting patient needs. To help address this challenge, this study describes health care utilization by youth in Nova Scotia. Our objective was to identify whether age, sex, socioeconomic status

Associations Between Socio-Economic Status and Child Health: Findings of a Large German Cohort Study

“…The social background of a family significantly impacts family residence, health care use or access, parenting, and, directly and indirectly, child behavior and development [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. A central indicator of a family’s social background is the socio-economic status (SES), which is usually reflected by parents’ education, occupation, and (equivalent household) income [ 8 ].…”

Characteristics of High-Resource Health System Users in Rural and Remote Regions: A Scoping Review

“…Of these, seven studies found females were higher resource users than males and six found that sex-based differences were dependent upon other factors. Females were identified as higher resource users in multiple health care settings, including health services for all ages [16,17,21,22,28], health services for youth [29,30], primary care for all ages, and adult emergency department presentations [21,31].…”

“…Women also had longer hospitalizations [17,20,2332]. Manos (2014) examined sex-based different in a population aged 12-24 years old in Nova Scotia, Canada. Females accounted for 2X more primary care and inpatient contacts and made up 84% of all high-resource users [29].…”

“…Two studies identified social and material deprivation as risk factors for high-resource use within an elderly cohort [17,29]. Social isolation and psychological distress were common in high-resource users, as a significant proportion lived alone and had lower social network scores [23].…”

“…Nine of the included studies identified measures of socioeconomic status as important characteristics of high-resource use. Of these, 7 studies identified low socioeconomic status as a characteristic of high-resource use [20,21,23,[28][29][30][31], whereas two studies determined that differences depended upon the health service being accessed [17,20]. Wallar (2020) found that lower income was one of the largest risk factors for highresource use for both males and females [20].…”