IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0229465.html
   My bibliography  Save this article

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

Author

Listed:
  • Lauren E Wallar
  • Laura C Rosella

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.

Suggested Citation

  • Lauren E Wallar & Laura C Rosella, 2020. "Risk factors for avoidable hospitalizations in Canada using national linked data: A retrospective cohort study," PLOS ONE, Public Library of Science, vol. 15(3), pages 1-21, March.
    • Handle: RePEc:plo:pone00:0229465
    DOI: 10.1371/journal.pone.0229465
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229465
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0229465&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0229465?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Pappas, G. & Hadden, W.C. & Kozak, L.J. & Fisher, G.F., 1997. "Potentially avoidable hospitalizations: Inequalities in rates between US socioeconomic groups," American Journal of Public Health, American Public Health Association, vol. 87(5), pages 811-816.
    2. Laberge, Maude & Wodchis, Walter P. & Barnsley, Jan & Laporte, Audrey, 2017. "Hospitalizations for ambulatory care sensitive conditions across primary care models in Ontario, Canada," Social Science & Medicine, Elsevier, vol. 181(C), pages 24-33.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Leemore Dafny & Jonathan Gruber, 2000. "Does Public Insurance Improve the Efficiency of Medical Care? Medicaid Expansions and Child Hospitalizations," NBER Working Papers 7555, National Bureau of Economic Research, Inc.
    2. Lori J. Curtis & William J. MacMinn, 2008. "Health Care Utilization in Canada: Twenty-five Years of Evidence," Canadian Public Policy, University of Toronto Press, vol. 34(1), pages 65-88, March.
    3. Gusmano, Michael K. & Weisz, Daniel & Rodwin, Victor G. & Lang, Jonas & Qian, Meng & Bocquier, Aurelie & Moysan, Veronique & Verger, Pierre, 2014. "Disparities in access to health care in three French regions," Health Policy, Elsevier, vol. 114(1), pages 31-40.
    4. Rasha A. Mosallam & Wafaa W. Guirguis & Mona HA Hassan, 2014. "Hospitalization for ambulatory care sensitive conditions at health insurance organization hospitals in Alexandria, Egypt," International Journal of Health Planning and Management, Wiley Blackwell, vol. 29(4), pages 394-405, October.
    5. Tom W. Smith & Jibum Kim, 2013. "An Assessment of the Multi-level Integrated Database Approach," The ANNALS of the American Academy of Political and Social Science, , vol. 645(1), pages 185-221, January.
    6. Abdoul Aziz Ndiaye & Alioune Badara Tall & Ndeye Fatou Ngom-Gueye & Ousseynou Ka & Birahim Thiam & Amadou Barro Mbodj & Cheikh Tacko Diop & Awa Diop-B & Lamine Gueye & Anta Tal-Dia, 2017. "Potentially Avoidable Hospitalizations at Grand Yoff General Hospital, Senegal," Global Journal of Health Science, Canadian Center of Science and Education, vol. 9(10), pages 137-137, October.
    7. Duminy, Lize & Ress, Vanessa & Wild, Eva-Maria, 2022. "Complex community health and social care interventions – Which features lead to reductions in hospitalizations for ambulatory care sensitive conditions? A systematic literature review," Health Policy, Elsevier, vol. 126(12), pages 1206-1225.
    8. Dan L. Crouse & Kyle Rogers & Adele Balram & James T. McDonald, 2022. "The Impact of Rural Hospital Closures and Health Service Restructuring on Provincial- and Community-Level Patterns of Hospital Admissions in New Brunswick," IJERPH, MDPI, vol. 19(12), pages 1-13, June.
    9. Denise de Fátima Barros Cavalcante & Valéria Silva Cândido Brizon & Livia Fernandes Probst & Marcelo de Castro Meneghim & Antonio Carlos Pereira & Gláucia Maria Bovi Ambrosano, 2018. "Did the Family Health Strategy have an impact on indicators of hospitalizations for stroke and heart failure? Longitudinal study in Brazil: 1998-2013," PLOS ONE, Public Library of Science, vol. 13(6), pages 1-10, June.
    10. Genevieve E O'Connor, 2016. "Investigating the significance of insurance and income on health service utilization across generational cohorts," Journal of Financial Services Marketing, Palgrave Macmillan, vol. 21(1), pages 19-33, March.
    11. Marissa B Kosnik & David M Reif & Danelle T Lobdell & Thomas Astell-Burt & Xiaoqi Feng & John D Hader & Jane A Hoppin, 2019. "Associations between access to healthcare, environmental quality, and end-stage renal disease survival time: Proportional-hazards models of over 1,000,000 people over 14 years," PLOS ONE, Public Library of Science, vol. 14(3), pages 1-17, March.
    12. Yu-Han Hung & Yu-Chieh Chung & Pi-Yueh Lee & Hao-Yun Kao, 2021. "Exploration of Preventable Hospitalizations for Colorectal Cancer with the National Cancer Control Program in Taiwan," IJERPH, MDPI, vol. 18(17), pages 1-9, September.
    13. Gusmano, Michael K. & Weisz, Daniel & Mercier, Grégoire & Vasile, Maria & Rodwin, Victor G., 2023. "Access to outpatient care in Manhattan and Paris: A tale of real change in two world cities," Health Policy, Elsevier, vol. 132(C).
    14. Laberge, Maude & Gaudreault, Myriam, 2019. "Promoting access to family medicine in Québec, Canada: Analysis of bill 20, enacted in November 2015," Health Policy, Elsevier, vol. 123(10), pages 901-905.
    15. Spycher, Jacques & Morisod, Kevin & Moschetti, Karine & Le Pogam, Marie-Annick & Peytremann-Bridevaux, Isabelle & Bodenmann, Patrick & Cookson, Richard & Rodwin, Victor & Marti, Joachim, 2024. "Potentially avoidable hospitalizations and socioeconomic status in Switzerland: A small area-level analysis," Health Policy, Elsevier, vol. 139(C).
    16. Ting Chen & Jay Pan, 2022. "The Effect of Spatial Access to Primary Care on Potentially Avoidable Hospitalizations of the Elderly: Evidence from Chishui City, China," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 160(2), pages 645-665, April.
    17. Kaestner, Robert & Sasso, Anthony T. Lo, 2015. "Does seeing the doctor more often keep you out of the hospital?," Journal of Health Economics, Elsevier, vol. 39(C), pages 259-272.
    18. Chen, Andrew & Hwang, Yuhchang & Shao, Benjamin, 2005. "Measurement and sources of overall and input inefficiencies: Evidences and implications in hospital services," European Journal of Operational Research, Elsevier, vol. 161(2), pages 447-468, March.
    19. Merkin, Sharon Stein & Diez Roux, Ana V. & Coresh, Josef & Fried, Linda F. & Jackson, Sharon A. & Powe, Neil R., 2007. "Individual and neighborhood socioeconomic status and progressive chronic kidney disease in an elderly population: The Cardiovascular Health Study," Social Science & Medicine, Elsevier, vol. 65(4), pages 809-821, August.
    20. Nolan, Anne, 2011. "An extension in eligibility for free primary care and avoidable hospitalisations: A natural experiment," Social Science & Medicine, Elsevier, vol. 73(7), pages 978-985.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0229465. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.