Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Public Health Ontario, Toronto, Ontario, Canada.
PLoS One. 2020 Mar 17;15(3):e0229465. doi: 10.1371/journal.pone.0229465. eCollection 2020.
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.
由于有效的和及时的初级保健管理，某些慢性疾病的住院治疗被认为是可以避免的，对于加拿大的成年人而言。个人层面的风险因素，如收入和健康行为，在大多数医院数据库中通常不会收集，因此，在国家层面上，对于可避免的住院治疗，这些因素在很大程度上没有得到描述。本研究的目的是使用链接数据识别和描述加拿大可避免住院治疗的人口统计学、社会经济和健康行为风险因素。通过汇总加拿大社区健康调查的 8 个周期（2000/2001-2011 年）并链接到 1999/2000-2012/2013 年的出院摘要数据库中的住院记录，进行了一项全国回顾性队列研究。在基线时年龄小于 18 岁和大于 74 岁、居住在魁北克省或怀孕的受访者被排除在外，最终产生了 389065 名个体的队列。主要结局指标是指数可避免住院的时间。对性别分层的 Cox 比例风险模型进行了构建，以确定调整各种因素及其相关 95%置信区间后的效应大小。在男性和女性中，人口统计学、社会经济地位和健康行为与可避免住院的风险相关。在完全调整的模型中，健康行为变量的效应大小最大，包括重度吸烟（男性 HR 2.65（95%CI 2.17-3.23）；女性 HR 3.41（2.81-4.13））和体重不足（男性 HR 1.98（1.14-3.43）；女性 HR 2.78（1.61-4.81））。在两性中，移民身份均具有保护作用（男性 HR 0.83（0.69-0.98）；（女性 HR 0.69（0.57-0.84））。调整行为和临床变量减弱了个体社会经济地位的影响。本研究使用最大的全国性链接健康调查和住院记录数据库，根据性别确定了几个可避免住院时间的风险因素。几个可改变的风险因素的较大效应大小突出了预防在解决加拿大可避免住院治疗方面的重要性。
