Department of Computer Science, Hong Kong Baptist University, Kowloon Tong, Hong Kong.
BMC Health Serv Res. 2013 Jul 1;13:239. doi: 10.1186/1472-6963-13-239.
Although literature has associated geodemographic factors with healthcare service utilization, little is known about how these factors - such as population size, age profile, service accessibility, and educational profile - interact to influence service utilization. This study fills this gap in the literature by examining both the direct and the moderating effects of geodemographic profiles on the utilization of cardiac surgery services.
We aggregated secondary data obtained from Statistics Canada and Cardiac Care Network of Ontario to derive the geodemographic profiles of Ontario and the corresponding cardiac surgery service utilization in the years between 2004 and 2007. We conducted a two-step test using Partial Least Squares-based structural equation modeling to investigate the relationships between geodemographic profiles and healthcare service utilization.
Population size and age profile have direct positive effects on service utilization (β = 0.737, p < 0.01; β = 0.284, p < 0.01, respectively), whereas service accessibility is negatively associated with service utilization (β = -0.210, p < 0.01). Service accessibility decreases the effect of population size on service utilization (β = -0.606, p < 0.01), and educational profile weakens the effects of population size and age profile on service utilization (β = -0.595, p < 0.01; β = -0.286, p < 0.01, respectively).
In this study, we found that (1) service accessibility has a moderating effect on the relationship between population size and service utilization, and (2) educational profile has moderating effects on both the relationship between population size and service utilization, and the relationship between age profile and service utilization. Our findings suggest that reducing regional disparities in healthcare service utilization should take into account the interaction of geodemographic factors such as service accessibility and education. In addition, the allocation of resources for a particular healthcare service in one area should consider the geographic distribution of the same services in neighboring areas, as patients may be willing to utilize these services in areas not far from where they reside.
尽管文献已经将地理人口统计学因素与医疗服务利用相关联，但对于这些因素（如人口规模、年龄结构、服务可及性和教育程度）如何相互作用影响服务利用，人们知之甚少。本研究通过检查地理人口统计学特征对心脏手术服务利用的直接和调节作用，填补了这一文献空白。
我们汇总了从加拿大统计局和安大略省心脏护理网络获得的二级数据，得出了安大略省的地理人口统计学特征以及 2004 年至 2007 年期间相应的心脏手术服务利用情况。我们使用基于偏最小二乘法的结构方程模型进行了两步测试，以研究地理人口统计学特征与医疗服务利用之间的关系。
人口规模和年龄结构对服务利用有直接的正向影响（β=0.737，p<0.01；β=0.284，p<0.01），而服务可及性与服务利用呈负相关（β=-0.210，p<0.01）。服务可及性降低了人口规模对服务利用的影响（β=-0.606，p<0.01），教育程度削弱了人口规模和年龄结构对服务利用的影响（β=-0.595，p<0.01；β=-0.286，p<0.01）。
在这项研究中，我们发现：（1）服务可及性对人口规模与服务利用之间的关系具有调节作用；（2）教育程度对人口规模与服务利用之间的关系以及年龄结构与服务利用之间的关系均具有调节作用。我们的研究结果表明，减少医疗服务利用的区域差异应考虑服务可及性和教育等地理人口统计学因素的相互作用。此外，在一个地区分配特定医疗服务的资源时，应考虑到邻近地区相同服务的地理分布情况，因为患者可能愿意在离他们居住的地方不远的地方利用这些服务。
