Risk factors for avoidable hospitalizations in Canada using national linked data: A retrospective cohort study
Hospitalizations for certain chronic conditions are considered avoidable for adult Canadians given effective and timely primary care management. Individual-level risk factors such as income and health behaviours are not routinely collected in most hospital databases and as a result, are largely unch...
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| description | Hospitalizations for certain chronic conditions are considered avoidable for adult Canadians given effective and timely primary care management. Individual-level risk factors such as income and health behaviours are not routinely collected in most hospital databases and as a result, are largely uncharacterized for avoidable hospitalization at the national level. The aim of this study was to identify and describe demographic, socioeconomic, and health behavioural risk factors for avoidable hospitalizations in Canada using linked data. A national retrospective cohort study was conducted by pooling eight cycles of the Canadian Community Health Survey (2000/2001-2011) and linking to hospitalization records in the Discharge Abstract Database (1999/2000-2012/2013). Respondents who were younger than 18 years and older than 74 years of age, residing in Quebec, or pregnant at baseline were excluded yielding a final cohort of 389,065 individuals. The primary outcome measure was time-to index avoidable hospitalization. Sex-stratified Cox proportional hazard models were constructed to determine effect sizes adjusted for various factors and their associated 95% confidence intervals. Demographics, socioeconomic status, and health behaviours are associated with risk of avoidable hospitalizations in males and females. In fully adjusted models, health behavioural variables had the largest effect sizes including heavy smoking (Male HR 2.65 (95% CI 2.17-3.23); Female HR 3.41 (2.81-4.13)) and being underweight (Male HR 1.98 (1.14-3.43); Female HR 2.78 (1.61-4.81)). Immigrant status was protective in both sexes (Male HR 0.83 (0.69-0.98); (Female HR 0.69 (0.57-0.84)). Adjustment for behavioural and clinical variables attenuated the effect of individual-level socioeconomic status. This study identified several risk factors for time-to-avoidable hospitalizations by sex, using the largest national database of linked health survey and hospitalization records. The larger effect sizes of several modifiable risk factors highlights the importance of prevention in addressing avoidable hospitalizations in Canada. |
| doi_str_mv | 10.1371/journal.pone.0229465 |
| format | Article |
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Individual-level risk factors such as income and health behaviours are not routinely collected in most hospital databases and as a result, are largely uncharacterized for avoidable hospitalization at the national level. The aim of this study was to identify and describe demographic, socioeconomic, and health behavioural risk factors for avoidable hospitalizations in Canada using linked data. A national retrospective cohort study was conducted by pooling eight cycles of the Canadian Community Health Survey (2000/2001-2011) and linking to hospitalization records in the Discharge Abstract Database (1999/2000-2012/2013). Respondents who were younger than 18 years and older than 74 years of age, residing in Quebec, or pregnant at baseline were excluded yielding a final cohort of 389,065 individuals. The primary outcome measure was time-to index avoidable hospitalization. Sex-stratified Cox proportional hazard models were constructed to determine effect sizes adjusted for various factors and their associated 95% confidence intervals. Demographics, socioeconomic status, and health behaviours are associated with risk of avoidable hospitalizations in males and females. In fully adjusted models, health behavioural variables had the largest effect sizes including heavy smoking (Male HR 2.65 (95% CI 2.17-3.23); Female HR 3.41 (2.81-4.13)) and being underweight (Male HR 1.98 (1.14-3.43); Female HR 2.78 (1.61-4.81)). Immigrant status was protective in both sexes (Male HR 0.83 (0.69-0.98); (Female HR 0.69 (0.57-0.84)). Adjustment for behavioural and clinical variables attenuated the effect of individual-level socioeconomic status. This study identified several risk factors for time-to-avoidable hospitalizations by sex, using the largest national database of linked health survey and hospitalization records. The larger effect sizes of several modifiable risk factors highlights the importance of prevention in addressing avoidable hospitalizations in Canada.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0229465</identifier><identifier>PMID: 32182242</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adults ; Age ; Alcohol use ; Ambulatory care ; Angina pectoris ; Asthma ; Biology and Life Sciences ; Canadians ; Chronic conditions ; Chronic illnesses ; Chronic obstructive pulmonary disease ; Codes ; Cohort analysis ; Confidence intervals ; Datasets ; Demographics ; Demography ; Diabetes ; Females ; Health aspects ; Health behavior ; Health care ; Health risks ; Health surveys ; Hypertension ; Immigrants ; Male identity ; Males ; Medical research ; Medicine and Health Sciences ; People and places ; Polls & surveys ; Pregnant women ; Primary care ; Public health ; Risk analysis ; Risk factors ; Risk management ; Risk taking ; Sex ; Social class ; Socioeconomic factors ; Socioeconomics ; Statistical models ; Studies ; Surveys ; Survival analysis ; Time ; Trends ; Underweight ; Variables</subject><ispartof>PloS one, 2020-03, Vol.15 (3), p.e0229465-e0229465</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Wallar, Rosella. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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Individual-level risk factors such as income and health behaviours are not routinely collected in most hospital databases and as a result, are largely uncharacterized for avoidable hospitalization at the national level. The aim of this study was to identify and describe demographic, socioeconomic, and health behavioural risk factors for avoidable hospitalizations in Canada using linked data. A national retrospective cohort study was conducted by pooling eight cycles of the Canadian Community Health Survey (2000/2001-2011) and linking to hospitalization records in the Discharge Abstract Database (1999/2000-2012/2013). Respondents who were younger than 18 years and older than 74 years of age, residing in Quebec, or pregnant at baseline were excluded yielding a final cohort of 389,065 individuals. The primary outcome measure was time-to index avoidable hospitalization. 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The larger effect sizes of several modifiable risk factors highlights the importance of prevention in addressing avoidable hospitalizations in Canada.</description><subject>Adults</subject><subject>Age</subject><subject>Alcohol use</subject><subject>Ambulatory care</subject><subject>Angina pectoris</subject><subject>Asthma</subject><subject>Biology and Life Sciences</subject><subject>Canadians</subject><subject>Chronic conditions</subject><subject>Chronic illnesses</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Codes</subject><subject>Cohort analysis</subject><subject>Confidence intervals</subject><subject>Datasets</subject><subject>Demographics</subject><subject>Demography</subject><subject>Diabetes</subject><subject>Females</subject><subject>Health aspects</subject><subject>Health behavior</subject><subject>Health care</subject><subject>Health risks</subject><subject>Health 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factors for avoidable hospitalizations in Canada using national linked data: A retrospective cohort study</title><author>Wallar, Lauren E ; Rosella, Laura C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-bf7a315d7ec3ea977d7029d838fe7c9ef4cff3d7574e1edacf33ef54f71140053</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adults</topic><topic>Age</topic><topic>Alcohol use</topic><topic>Ambulatory care</topic><topic>Angina pectoris</topic><topic>Asthma</topic><topic>Biology and Life Sciences</topic><topic>Canadians</topic><topic>Chronic conditions</topic><topic>Chronic illnesses</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Codes</topic><topic>Cohort analysis</topic><topic>Confidence intervals</topic><topic>Datasets</topic><topic>Demographics</topic><topic>Demography</topic><topic>Diabetes</topic><topic>Females</topic><topic>Health 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One</addtitle><date>2020-03-17</date><risdate>2020</risdate><volume>15</volume><issue>3</issue><spage>e0229465</spage><epage>e0229465</epage><pages>e0229465-e0229465</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Hospitalizations for certain chronic conditions are considered avoidable for adult Canadians given effective and timely primary care management. Individual-level risk factors such as income and health behaviours are not routinely collected in most hospital databases and as a result, are largely uncharacterized for avoidable hospitalization at the national level. The aim of this study was to identify and describe demographic, socioeconomic, and health behavioural risk factors for avoidable hospitalizations in Canada using linked data. A national retrospective cohort study was conducted by pooling eight cycles of the Canadian Community Health Survey (2000/2001-2011) and linking to hospitalization records in the Discharge Abstract Database (1999/2000-2012/2013). Respondents who were younger than 18 years and older than 74 years of age, residing in Quebec, or pregnant at baseline were excluded yielding a final cohort of 389,065 individuals. The primary outcome measure was time-to index avoidable hospitalization. Sex-stratified Cox proportional hazard models were constructed to determine effect sizes adjusted for various factors and their associated 95% confidence intervals. Demographics, socioeconomic status, and health behaviours are associated with risk of avoidable hospitalizations in males and females. In fully adjusted models, health behavioural variables had the largest effect sizes including heavy smoking (Male HR 2.65 (95% CI 2.17-3.23); Female HR 3.41 (2.81-4.13)) and being underweight (Male HR 1.98 (1.14-3.43); Female HR 2.78 (1.61-4.81)). Immigrant status was protective in both sexes (Male HR 0.83 (0.69-0.98); (Female HR 0.69 (0.57-0.84)). Adjustment for behavioural and clinical variables attenuated the effect of individual-level socioeconomic status. This study identified several risk factors for time-to-avoidable hospitalizations by sex, using the largest national database of linked health survey and hospitalization records. The larger effect sizes of several modifiable risk factors highlights the importance of prevention in addressing avoidable hospitalizations in Canada.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32182242</pmid><doi>10.1371/journal.pone.0229465</doi><tpages>e0229465</tpages><orcidid>https://orcid.org/0000-0003-4867-869X</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2020-03, Vol.15 (3), p.e0229465-e0229465 |
| issn | 1932-6203 1932-6203 |
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| source | DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adults Age Alcohol use Ambulatory care Angina pectoris Asthma Biology and Life Sciences Canadians Chronic conditions Chronic illnesses Chronic obstructive pulmonary disease Codes Cohort analysis Confidence intervals Datasets Demographics Demography Diabetes Females Health aspects Health behavior Health care Health risks Health surveys Hypertension Immigrants Male identity Males Medical research Medicine and Health Sciences People and places Polls & surveys Pregnant women Primary care Public health Risk analysis Risk factors Risk management Risk taking Sex Social class Socioeconomic factors Socioeconomics Statistical models Studies Surveys Survival analysis Time Trends Underweight Variables |
| title | Risk factors for avoidable hospitalizations in Canada using national linked data: A retrospective cohort study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-23T22%3A42%3A09IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Risk%20factors%20for%20avoidable%20hospitalizations%20in%20Canada%20using%20national%20linked%20data:%20A%20retrospective%20cohort%20study&rft.jtitle=PloS%20one&rft.au=Wallar,%20Lauren%20E&rft.date=2020-03-17&rft.volume=15&rft.issue=3&rft.spage=e0229465&rft.epage=e0229465&rft.pages=e0229465-e0229465&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0229465&rft_dat=%3Cgale_plos_%3EA617767803%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2377943123&rft_id=info:pmid/32182242&rft_galeid=A617767803&rft_doaj_id=oai_doaj_org_article_49615b6b35a4453d97cb14ac13706d4a&rfr_iscdi=true |