{"id":2864,"date":"2020-07-31T00:00:00","date_gmt":"2020-07-31T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/direct-and-indirect-pathways-between-low-income-status-and-becoming-a-high-cost-healthcare-user-in-ontario-canada-a-mediation-analysis-of-health-risk-behaviors\/"},"modified":"2023-06-14T19:26:24","modified_gmt":"2023-06-14T23:26:24","slug":"direct-and-indirect-pathways-between-low-income-status-and-becoming-a-high-cost-healthcare-user-in-ontario-canada-a-mediation-analysis-of-health-risk-behaviors","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/direct-and-indirect-pathways-between-low-income-status-and-becoming-a-high-cost-healthcare-user-in-ontario-canada-a-mediation-analysis-of-health-risk-behaviors\/","title":{"rendered":"Direct and indirect pathways between low income status and becoming a high-cost healthcare user in Ontario, Canada: a mediation analysis of health risk behaviors"},"content":{"rendered":"<p><strong>Purpose <\/strong>&#x2014; We investigated natural direct and indirect pathways between low income status and high-cost user (HCU) transitions considering health risk behaviors as potential mediators.<\/p>\n<p><strong>Methods <\/strong>&#x2014; We analyzed data from respondents (aged 18+) from four pooled cycles of the Canadian Community Health Survey (2005-2010\/2011) linked to administrative data in Ontario, Canada. HCUs were defined as the top 5% of the population, ranked by cost consumption in any of the five years following survey interview. Low income status was defined from the provincial distribution of self-reported household income, with missing values imputed from neighborhood-level data. In mediation analyses based on marginal structural models, we quantified the contributions of smoking, physical inactivity, alcohol consumption and body-mass index (BMI) to income-HCU associations.<\/p>\n<p><strong>Results <\/strong>&#x2014; 115,091 respondents (representative of 9,661,764 Ontarians) were included in the study, of which 7.2% became HCU. The odds of becoming HCU were 1.36 times (95% CI: 1.25-1.48) greater for low (vs. high) income status respondents. Smoking, physical activity, alcohol consumption and BMI contributed 9.4%, 6.5%, 10.6% and 4.4% to this association, respectively. Tests for exposure-mediator interactions were not statistically significant.<\/p>\n<p><strong>Conclusions <\/strong>&#x2014; Health risk behaviors only partially explain income inequalities in future HCU transitions.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Purpose &#x2014; We investigated natural direct and indirect pathways between low income status and high-cost user (HCU) transitions considering health risk behaviors as potential mediators. Methods &#x2014; We analyzed data from respondents (aged 18+) from four pooled cycles of the Canadian Community Health Survey (2005-2010\/2011) linked to administrative data in Ontario, Canada. HCUs were defined [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[],"migration-helper-qa-sample-set":[],"class_list":["post-2864","journal_article","type-journal_article","status-publish","hentry"],"acf":{"citation":"Mondor L, Watson T, Kornas K, Bornbaum C, Wodchis WP, Rosella LC. <em>Ann Epidemiol<\/em>. 2020; 51:28-34.e4. Epub 2020 Jul 31.","source_url":"https:\/\/doi.org\/10.1016\/j.annepidem.2020.07.006","ices_scientist":[1135,1339,16470],"site":[6733],"research_program":[6740],"news_release":[],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"7A1F3CDF-404F-467E-B6F6-25BAF3D5DD58","sitecore_item_name":"Direct-and-indirect-pathways-between-low-income-status-and-becoming-a-high-cost-healthcare","sitecore_field_values":"{\n  \"Title\": \"Direct and indirect pathways between low income status and becoming a high-cost healthcare user in Ontario, Canada: a mediation analysis of health risk behaviors\",\n  \"Short title\": \"Direct and indirect pathways between\",\n  \"Summary\": \"This study investigated natural direct and indirect pathways between low income status and high-cost user (HCU) transitions considering health risk behaviors as potential mediators.\",\n  \"Citation\": \"<p>Mondor L, Watson T, Kornas K, Bornbaum C, Wodchis WP, Rosella LC. <em>Ann Epidemiol<\/em>. 2020; 51:28-34.e4. Epub 2020 Jul 31. DOI: <a href=\"https:\/\/doi.org\/10.1016\/j.annepidem.2020.07.006\" title=\"Opens external link\">https:\/\/doi.org\/10.1016\/j.annepidem.2020.07.006<\/a><\/p>\",\n  \"Abstract\": \"<p><strong>Purpose <\/strong>&mdash; We investigated natural direct and indirect pathways between low income status and high-cost user (HCU) transitions considering health risk behaviors as potential mediators.<\/p>n<p><strong>Methods <\/strong>&mdash; We analyzed data from respondents (aged 18+) from four pooled cycles of the Canadian Community Health Survey (2005-2010\/2011) linked to administrative data in Ontario, Canada. HCUs were defined as the top 5% of the population, ranked by cost consumption in any of the five years following survey interview. Low income status was defined from the provincial distribution of self-reported household income, with missing values imputed from neighborhood-level data. In mediation analyses based on marginal structural models, we quantified the contributions of smoking, physical inactivity, alcohol consumption and body-mass index (BMI) to income-HCU associations.<\/p>n<p><strong>Results <\/strong>&mdash; 115,091 respondents (representative of 9,661,764 Ontarians) were included in the study, of which 7.2% became HCU. The odds of becoming HCU were 1.36 times (95% CI: 1.25-1.48) greater for low (vs. high) income status respondents. Smoking, physical activity, alcohol consumption and BMI contributed 9.4%, 6.5%, 10.6% and 4.4% to this association, respectively. Tests for exposure-mediator interactions were not statistically significant.<\/p>n<p><strong>Conclusions <\/strong>&mdash; Health risk behaviors only partially explain income inequalities in future HCU transitions.<\/p>\",\n  \"Research Programs\": \"{46DF28D2-EDE8-4DF2-8CC0-87CEF464E435}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n  \"ICES Scientists\": \"{26C6C411-14DA-4E2F-9D10-9564115ADE0A}|{430B2731-D3D6-4D57-9AF4-AA7626CF61B0}\",\n  \"Posted Date\": \"20200731T000000\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2020\/July\/Direct-and-indirect-pathways-between-low-income-status-and-becoming-a-high-cost-healthcare"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Direct and indirect pathways between low income status and becoming a high-cost healthcare user in Ontario, Canada: a mediation analysis of health risk behaviors<\/title>\n<meta name=\"description\" content=\"Purpose &#x2014; 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