Fisher Kathryn A, Griffith Lauren E, Gruneir Andrea, Upshur Ross, Perez Richard, Favotto Lindsay, Nguyen Francis, Markle-Reid Maureen, Ploeg Jenny
School of Nursing, McMaster University, HSC 2J36, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, CRL Building, First Floor, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
BMC Health Serv Res. 2021 Jan 13;21(1):62. doi: 10.1186/s12913-020-06032-5.
This study explores how socio-demographic and health factors shape the relationship between multimorbidity and one-year acute care service use (i.e., hospital, emergency department visits) in older adults in Ontario, Canada.
We linked multiple cycles (2005-2006, 2007-2008, 2009-2010, 2011-2012) of the Canadian Community Health Survey (CCHS) to health administrative data to create a cohort of adults aged 65 and older. Administrative data were used to estimate one-year service use and to identify 12 chronic conditions used to measure multimorbidity. We examined the relationship between multimorbidity and service use stratified by a range of socio-demographic and health variables available from the CCHS. Logistic and Poisson regressions were used to explore the association between multimorbidity and service use and the role of socio-demographic factors in this relationship.
Of the 28,361 members of the study sample, 60% were between the ages of 65 and 74 years, 57% were female, 72% were non-immigrant, and over 75% lived in an urban area. Emergency department visits and hospitalizations consistently increased with the level of multimorbidity. This study did not find strong evidence of moderator or interaction effects across a range of socio-demographic factors. Stratified analyses revealed further patterns, with many being similar for both services - e.g., the odds ratios were higher at all levels of multimorbidity for men, older age groups, and those with lower household income. Rurality and immigrant status influenced emergency department use (higher in rural residents and non-immigrants) but not hospitalizations. Multimorbidity and the range of socio-demographic variables remained significant predictors of service use in the regressions.
Strong evidence links multimorbidity with increased acute care service use. This study showed that a range of factors did not modify this relationship. Nevertheless, the factors were independently associated with acute care service use, pointing to modifiable risk factors that can be the focus of resource allocation and intervention design to reduce service use in those with multimorbidity. The study's results suggest that optimizing acute care service use in older adults requires attention to both multimorbidity and social determinants, with programs that are multifactorial and integrated across the health and social service sectors.
本研究探讨社会人口统计学和健康因素如何塑造加拿大安大略省老年人中多种疾病并存与一年期急性护理服务使用（即住院、急诊就诊）之间的关系。
我们将加拿大社区健康调查（CCHS）的多个周期（2005 - 2006年、2007 - 2008年、2009 - 2010年、2011 - 2012年）与健康管理数据相链接，以创建一个65岁及以上成年人队列。管理数据用于估计一年期服务使用情况，并确定用于衡量多种疾病并存的12种慢性病。我们研究了多种疾病并存与服务使用之间的关系，并根据CCHS中一系列社会人口统计学和健康变量进行分层。使用逻辑回归和泊松回归来探讨多种疾病并存与服务使用之间的关联以及社会人口统计学因素在这种关系中的作用。
在研究样本的28361名成员中，60%年龄在65至74岁之间，57%为女性，72%为非移民，超过75%居住在城市地区。急诊就诊和住院次数随多种疾病并存程度的增加而持续增加。本研究未发现一系列社会人口统计学因素存在调节或交互作用的有力证据。分层分析揭示了进一步的模式，两种服务的许多模式相似——例如，在所有多种疾病并存水平上，男性、年龄较大的群体以及家庭收入较低者的比值比更高。农村地区和移民身份影响急诊使用（农村居民和非移民中更高），但不影响住院情况。在回归分析中，多种疾病并存和一系列社会人口统计学变量仍然是服务使用的重要预测因素。
有力证据表明多种疾病并存与急性护理服务使用增加有关。本研究表明，一系列因素并未改变这种关系。然而，这些因素与急性护理服务使用独立相关，指出了可改变的风险因素，这些因素可成为资源分配和干预设计的重点，以减少多种疾病并存者的服务使用。研究结果表明，优化老年人的急性护理服务使用需要关注多种疾病并存和社会决定因素，开展跨健康和社会服务部门的多因素综合项目。
