High Health Care Utilization and Costs Associated with Lower Socio-economic Status: Results from a Linked Dataset

Objective: The purpose of this paper was to use a linked dataset to compare health care utilization rates and costs between income groups in Saskatoon, Canada. Methods: The Canadian Community Health Survey was linked to hospital, physician and medication data in Saskatoon. Results: Of 3,688 eligible participants, 3,433 agreed to the health survey and data linkage with health records (83.7% overall response). Low-income residents were 27-33% more likely to be hospitalized and 36-45% more likely to receive a medication than middle- and higher-income residents, but were 5-7% less likely to visit a physician over a one-year period. In comparison to middle-income residents, low-income residents had 56% more high users of hospitals, 166% more high users of physicians and 90% more high users of medications. Low-income residents had 34-35% higher health care costs overall than middle- and high-income residents. After multivariate adjustment for increased disease prevalence, low income had a reduced association with high health care utilization. Conclusions: The results demonstrate that residents with lower income are responsible for disproportionate usage of hospitals, physicians and medications; due mainly (but not entirely) to higher disease prevalence

Suicidal Ideation: The Role of Economic and Aboriginal Cultural Status After Multivariate Adjustment

Objective: To determine if Aboriginal (in this paper, First Nations and Metis people) cultural status is independently associated with lifetime suicidal Ideation in the Saskatoon Health Region after controlling for other covariates, particularly income status. Methods: Data collected by Statistics Canada in all 3 cycles of the Canadian Community Health Survey (CCHS) were merged with identical questions asked in February 2007 by the Saskatoon Health Region. The health outcome was lifetime suicidal ideation. The risk indicators included demographics, socioeconomic status, cultural status, behaviours, life stress, health care use, and other health problems. Results: Participants (n = 5948) completed the survey with a response rate of 81.1%. The prevalence of lifetime suicidal ideation was 11.9%. After stratification, it was found that high-income Aboriginal people have similar low levels of suicidal ideation, compared with high-income Caucasian people. The risk-hazard model demonstrated a larger independent effect of income status in explaining the association between Aboriginal cultural status and lifetime suicidal ideation, compared with the independent effect of age. After full multivariate adjustment, Aboriginal cultural status had a substantially reduced association with lifetime suicidal ideation. The odds of lifetime suicidal ideation for Aboriginal people reduced from 3.28 to 1.99 after multivariate adjustment for household income alone. Conclusion: The results of this study suggest reductions in lifetime suicidal ideation can be observed in Aboriginal people in Canada by adjusting levels of household income

Suicidal Ideation: The Role of Economic and Aboriginal Cultural Status After Multivariate Adjustment

Objective: To determine if Aboriginal (in this paper, First Nations and Metis people) cultural status is independently associated with lifetime suicidal Ideation in the Saskatoon Health Region after controlling for other covariates, particularly income status. Methods: Data collected by Statistics Canada in all 3 cycles of the Canadian Community Health Survey (CCHS) were merged with identical questions asked in February 2007 by the Saskatoon Health Region. The health outcome was lifetime suicidal ideation. The risk indicators included demographics, socioeconomic status, cultural status, behaviours, life stress, health care use, and other health problems. Results: Participants (n = 5948) completed the survey with a response rate of 81.1%. The prevalence of lifetime suicidal ideation was 11.9%. After stratification, it was found that high-income Aboriginal people have similar low levels of suicidal ideation, compared with high-income Caucasian people. The risk-hazard model demonstrated a larger independent effect of income status in explaining the association between Aboriginal cultural status and lifetime suicidal ideation, compared with the independent effect of age. After full multivariate adjustment, Aboriginal cultural status had a substantially reduced association with lifetime suicidal ideation. The odds of lifetime suicidal ideation for Aboriginal people reduced from 3.28 to 1.99 after multivariate adjustment for household income alone. Conclusion: The results of this study suggest reductions in lifetime suicidal ideation can be observed in Aboriginal people in Canada by adjusting levels of household income