{"id":4376,"date":"2015-05-08T00:00:00","date_gmt":"2015-05-08T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/looking-beyond-income-and-education-socioeconomic-status-gradients-among-future-high-cost-users-of-health-care\/"},"modified":"2023-06-14T19:26:37","modified_gmt":"2023-06-14T23:26:37","slug":"looking-beyond-income-and-education-socioeconomic-status-gradients-among-future-high-cost-users-of-health-care","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/looking-beyond-income-and-education-socioeconomic-status-gradients-among-future-high-cost-users-of-health-care\/","title":{"rendered":"Looking beyond income and education: socioeconomic status gradients among future high-cost users of healthcare"},"content":{"rendered":"<p><strong>Introduction<\/strong> &#x2014; Healthcare spending occurs disproportionately among a very small portion of the population. Research on these high-cost users (HCUs) of healthcare has been overwhelmingly cross-sectional in nature and limited to the few sociodemographic and clinical characteristics available in health administrative databases. This study is the first to bridge this knowledge gap by applying a population health lens to HCUs. We investigate associations between a broad range of SES characteristics and future HCUs. <\/p>\n<p><strong>Methods <\/strong>&#x2014; A cohort of adults from two cycles of large, nationally representative health surveys conducted in 2003 and 2005 was linked to population-based health administrative databases from a universal healthcare plan for Ontario, Canada. Comprehensive person-centered estimates of annual healthcare spending were calculated for the subsequent 5 years following interview. Baseline HCUs (top 5%) were excluded and healthcare spending for non-HCUs was analyzed. Adjusted for predisposition and need factors, the odds of future HCU status (over 5 years) were estimated according to various individual, household, and neighborhood SES factors. Analyses were conducted in 2014. <\/p>\n<p><strong>Results<\/strong> &#x2014; Low income (personal and household); less than post-secondary education; and living in high-dependency neighborhoods greatly increased the odds of future HCUs. After adjustment, future HCU status was most strongly associated with food insecurity, personal income, and nonhomeownership. Living in highly deprived or low ethnic concentration neighborhoods also increased the odds of becoming an HCU. <\/p>\n<p><strong>Conclusions<\/strong> &#x2014; Findings suggest that addressing social determinants of health, such as food and housing security, may be important components of interventions aiming to improve health outcomes and reduce costs.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Introduction &#x2014; Healthcare spending occurs disproportionately among a very small portion of the population. Research on these high-cost users (HCUs) of healthcare has been overwhelmingly cross-sectional in nature and limited to the few sociodemographic and clinical characteristics available in health administrative databases. This study is the first to bridge this knowledge gap by applying a [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[20,61],"migration-helper-qa-sample-set":[],"class_list":["post-4376","journal_article","type-journal_article","status-publish","hentry","topic-health-and-health-care-inequality","topic-health-economics"],"acf":{"citation":"Fitzpatrick T, Rosella LC, Calzavara A, Petch J, Pinto AD, Manson H, Goel V, Wodchis WP. <em>Am J Prev Med<\/em> 2015; 49(2):161-71. Epub 2015 May 8.","source_url":"http:\/\/ac.els-cdn.com\/S0749379715000823\/1-s2.0-S0749379715000823-main.pdf?_tid=e2b524de-f808-11e4-b69f-00000aacb360&acdnat=1431367957_44da3b7356f48dc120c03eeef1e485ef","ices_scientist":[1339,1253,1135,13131],"site":[6735],"research_program":[6740],"news_release":[7839],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"12B95184-135B-4F7D-8D57-26F99236C9CF","sitecore_item_name":"Looking-beyond-income-and-education-SES-gradients-among-future-high-cost-users-of-health-care","sitecore_field_values":"{\n  \"Title\": \"Looking beyond income and education: socioeconomic status gradients among future high-cost users of healthcare\",\n  \"Short title\": \"Looking beyond income and education\",\n  \"Summary\": \"Findings suggest that addressing social determinants of health, such as food and housing security, may be important components of interventions aiming to improve health outcomes and reduce costs.rnrn\",\n  \"Citation\": \"<p>Fitzpatrick T, Rosella LC, Calzavara A, Petch J, Pinto AD, Manson H, Goel V, Wodchis WP. <em>Am J Prev Med<\/em> 2015; 49(2):161-71. Epub 2015 May 8.<\/p>\",\n  \"Abstract\": \"<p><strong>Introduction<\/strong> &mdash; Healthcare spending occurs disproportionately among a very small portion of the population. Research on these high-cost users (HCUs) of healthcare has been overwhelmingly cross-sectional in nature and limited to the few sociodemographic and clinical characteristics available in health administrative databases. This study is the first to bridge this knowledge gap by applying a population health lens to HCUs. We investigate associations between a broad range of SES characteristics and future HCUs. <\/p>rn<p><strong>Methods <\/strong>&mdash; A cohort of adults from two cycles of large, nationally representative health surveys conducted in 2003 and 2005 was linked to population-based health administrative databases from a universal healthcare plan for Ontario, Canada. Comprehensive person-centered estimates of annual healthcare spending were calculated for the subsequent 5 years following interview. Baseline HCUs (top 5%) were excluded and healthcare spending for non-HCUs was analyzed. Adjusted for predisposition and need factors, the odds of future HCU status (over 5 years) were estimated according to various individual, household, and neighborhood SES factors. Analyses were conducted in 2014. <\/p>rn<p><strong>Results<\/strong> &mdash; Low income (personal and household); less than post-secondary education; and living in high-dependency neighborhoods greatly increased the odds of future HCUs. After adjustment, future HCU status was most strongly associated with food insecurity, personal income, and nonhomeownership. Living in highly deprived or low ethnic concentration neighborhoods also increased the odds of becoming an HCU. <\/p>rn<p><strong>Conclusions<\/strong> &mdash; Findings suggest that addressing social determinants of health, such as food and housing security, may be important components of interventions aiming to improve health outcomes and reduce costs.<\/p>rn<p><a href=\"http:\/\/ac.els-cdn.com\/S0749379715000823\/1-s2.0-S0749379715000823-main.pdf?_tid=e2b524de-f808-11e4-b69f-00000aacb360&amp;acdnat=1431367957_44da3b7356f48dc120c03eeef1e485ef\" title=\"external link to full text pdf opens in new window\" target=\"_blank\">View full text<\/a><\/p>\",\n  \"Keywords\": \"{404E8236-468F-4DA1-8BA1-F405AC36275E}|{5B386094-8417-4B93-9D08-2F46BC0458AB}\",\n  \"Related Products\": \"<h2>News release<\/h2>rn<h3><a href=\"~\/link.aspx?_id=05E2BD7CCA1F426F8C26C11FB78ADD09&amp;_z=z\">The risk of becoming a high-cost user of healthcare strongly linked to socio-economic status including income, education, homeownership and food security<\/a><\/h3>rn<h2><a href=\"~\/link.aspx?_id=2F3FF37C088747AA987C04BA1C142AE9&amp;_z=z\">In the news<\/a><\/h2>rn<h3><a href=\"http:\/\/www.cbc.ca\/news\/health\/poverty-linked-to-future-high-health-care-costs-1.3065822\" title=\"CBC.ca story \" target=\"_blank\">Poverty linked to future high health-care costs<\/a><\/h3>\",\n  \"Research Programs\": \"{46DF28D2-EDE8-4DF2-8CC0-87CEF464E435}|{5B1AF319-EC9B-4BF0-A9CD-D066ABE49D71}\",\n  \"ICES Locations\": \"{FBE2D1B1-C0BA-423F-8D16-39466B6C1424}\",\n  \"ICES Scientists\": \"{430B2731-D3D6-4D57-9AF4-AA7626CF61B0}|{4BF52DAD-DEB2-4DEE-9C76-F4EFADDD454A}|{26C6C411-14DA-4E2F-9D10-9564115ADE0A}|{9896A0CF-1FD3-454E-B574-37CFAA5B2613}\",\n  \"Posted Date\": \"20150508T000000\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2015\/January\/Looking-beyond-income-and-education-SES-gradients-among-future-high-cost-users-of-health-care"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Looking beyond income and education: socioeconomic status gradients among future high-cost users of healthcare<\/title>\n<meta name=\"description\" content=\"Introduction &#x2014; Healthcare spending occurs disproportionately among a very small portion of the population. 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