Disparities in the hospital cost of cardiometabolic diseases among lesbian, gay, and bisexual Canadians: a population-based cohort study using linked data.

OBJECTIVES

Sexual identity has been recognized as a social determinant of health; however, evidence is limited on sexual minority status as a possible contributor to inequalities in cardiometabolic outcomes and the related hospital burden. This study aimed to investigate the association between sexual identity and hospital costs for cardiometabolic diseases among a cohort of Canadians using linked survey and administrative data.

METHODS

Data from the 2007-2011 Canadian Community Health Survey were linked to acute-care inpatient records from the 2005/2006-2012/2013 Discharge Abstract Database. Multiple linear regression was used to assess the association between self-reported sexual identity and inpatient resource use for cardiometabolic diseases.

RESULTS

Among the population ages 18-59, 2.1% (95% CI 1.9-2.2) identified as lesbian, gay, or bisexual (LGB). LGB individuals more often reported having diabetes or heart disease compared with heterosexuals. The mean inflation-adjusted cost for cardiometabolic-related hospitalizations was found to be significantly higher among LGB patients (CAD$26,702; 95% CI 26,166-60,365) than among their heterosexual counterparts ($10,137; 95% CI 8,639-11,635), in part a reflection of longer hospital stays (13.6 days versus 5.1 days). Inpatient costs remained 54% (95% CI 8-119) higher among LGB patients after controlling for socio-demographics, health status, and health behaviours.

CONCLUSION

This study revealed a disproportionate cost for potentially avoidable hospitalizations for cardiometabolic conditions among LGB patients, suggesting important unmet healthcare needs even in the Canadian context of universal coverage.