Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
PLoS One. 2023 Feb 2;18(2):e0280961. doi: 10.1371/journal.pone.0280961. eCollection 2023.
Although care use should parallel needs, enabling and predisposing circumstances including the socio-demographic inequities of socioeconomic status (SES), gender, or isolation often intervene to diminish care. We examine whether availability of state-funded medical and support services at home can rebalance these individual and social inequities, and do this by identifying if and how intersecting social identities predict homecare use among older Canadian adults.
Using the Canadian Longitudinal Study on Aging (CLSA) of 30,097 community-dwelling adults aged 45 to 85, we performed recursive partitioning regression tree analysis using Chi-Squared automatic interaction detection (CHAID). Combinations of individual and social characteristics including sociodemographic, family-related, physical and psychological measures and contextual indicators of material and social deprivation were explored as possible predictors of formal and informal care use.
Diminished function i.e. increased need, indicated by Activities of Daily Living, was most strongly aligned with formal care use while age, living arrangement, having no partner, depression, self-rated health and chronic medical conditions playing a lesser role in the pathway to use. Notably, sex/gender, were not determinants. Characteristics aligned with informal care were first-need, then country of birth and years since immigration. Both 'trees' showed high validity with low risk of misclassification (4.6% and 10.8% for formal and informal care, respectively).
Although often considered marginalised, women, immigrants, or those of lower SES utilised formal care equitably. Formal care was also differentially available to those without the financial or human resources to receive informal care. Need, primarily medical but also arising from living arrangement, rather than SES or gender predicted formal care, indicating that universal government-funded services may rebalance social and individual inequities in formal care use.
尽管医疗保健的使用应与需求相匹配，但使能因素和促成因素（包括社会人口经济地位、性别或隔离等社会经济不平等）常常会干预，从而减少医疗保健的使用。我们通过确定交叉社会身份是否以及如何预测加拿大老年成年人的家庭护理使用情况，来研究家庭中是否有州资助的医疗和支持服务来平衡这些个人和社会不平等。
我们使用加拿大老龄化纵向研究（CLSA）的 30097 名年龄在 45 至 85 岁之间的社区居住成年人的数据，使用卡方自动交互检测（CHAID）进行递归分区回归树分析。包括社会人口统计学、家庭相关、身体和心理测量以及物质和社会剥夺的环境指标在内的个体和社会特征的组合，被探索为正规和非正规护理使用的可能预测因素。
日常生活活动（ADL）能力下降表明需求增加，这与正规护理使用最相关，而年龄、居住安排、没有伴侣、抑郁、自我报告的健康状况和慢性疾病在使用途径中作用较小。值得注意的是，性别/性别并不是决定因素。与非正规护理相关的特征是第一需求，其次是出生国和移民年限。这两个“树”都具有较高的有效性和较低的分类错误风险（正规和非正规护理分别为 4.6%和 10.8%）。
尽管女性、移民或社会经济地位较低的人通常被认为处于边缘地位，但他们也平等地获得正规护理。那些没有财务或人力资源获得非正规护理的人也可以获得正规护理。需求，主要是医疗需求，但也来自居住安排，而不是社会经济地位或性别，预测正规护理，这表明普遍的政府资助服务可能会平衡正规护理使用中的社会和个人不平等。
