Open AccessLooking beyond Administrative Health Care Data: The Role of Socioeconomic Status in Predicting Future High-cost Patients with Mental Health and Addiction
Author(s) -
Claire de Oliveira,
Luke Mondor,
Walter P. Wodchis,
Laura Rosella
Publication year - 2021
Publication title -
the canadian journal of psychiatry/canadian journal of psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.68
H-Index - 117
eISSN - 1497-0015
pISSN - 0706-7437
DOI - 10.1177/07067437211004882
Subject(s) - socioeconomic status , mental health , addiction , public health , odds ratio , confidence interval , health care , medicine , demography , mental illness , household income , gerontology , odds , logistic regression , environmental health , psychology , psychiatry , population , geography , nursing , economics , archaeology , pathology , sociology , economic growth
Previous research has shown that the socioeconomic status (SES)–health gradient also extends to high-cost patients; however, little work has examined high-cost patients with mental illness and/or addiction. The objective of this study was to examine associations between individual-, household- and area-level SES factors and future high-cost use among these patients.Methods: We linked survey data from adult participants (ages 18 and older) of 3 cycles of the Canadian Community Health Survey to administrative health care data from Ontario, Canada. Respondents with mental illness and/or addiction were identified based on prior mental health and addiction health care use and followed for 5 years for which we ascertained health care costs covered under the public health care system. We quantified associations between SES factors and becoming a high-cost patient (i.e., transitioning into the top 5%) using logistic regression models. For ordinal SES factors, such as income, education and marginalization variables, we measured absolute and relative inequalities using the slope and relative index of inequality.Results: Among our sample, lower personal income (odds ratio [ OR] = 2.11, 95% confidence interval [CI], 1.54 to 2.88, for CAD$0 to CAD$14,999), lower household income ( OR = 2.11, 95% CI, 1.49 to 2.99, for lowest income quintile), food insecurity ( OR = 1.87, 95% CI, 1.38 to 2.55) and non-homeownership ( OR = 1.34, 95% CI, 1.08 to 1.66), at the individual and household levels, respectively, and higher residential instability (OR = 1.72, 95% CI, 1.23 to 2.42, for most marginalized), at the area level, were associated with higher odds of becoming a high-cost patient within a 5-year period. Moreover, the inequality analysis suggested pro-high-SES gradients in high-cost transitions.Conclusions: Policies aimed at high-cost patients with mental illness and/or addiction, or those concerned with preventing individuals with these conditions from becoming high-cost patients in the health care system, should also consider non-clinical factors such as income as well as related dimensions including food security and homeownership.