Background
Methods
Study context
Data sources
Study design and cohort creation
Exposure definition
Outcome definition
Covariates
Overall (n = 120,752) | Any financial barrier (n = 12,303)* | No financial barrier (n = 108,449) |
p (chi square) | |||||
---|---|---|---|---|---|---|---|---|
n
| % |
n
| % |
n
| % | |||
Age | 45–64 years | 50,228 | 41.6 | 7470 | 60.7 | 42,758 | 39.4 | <0.001 |
65–74 years | 33,951 | 28.1 | 2766 | 22.5 | 31,185 | 28.8 | ||
75+ | 36,573 | 30.3 | 2067 | 16.8 | 34,506 | 31.8 | ||
Demographic characteristics | Sex: male | 53,098 | 44.0 | 4882 | 39.7 | 48,216 | 44.5 | <0.001 |
Marital Status: married | 67,725 | 56.1 | 5010 | 40.8 | 62,715 | 57.9 | <0.001 | |
Residence: rural | 34,386 | 28.5 | 3320 | 27.0 | 31,066 | 28.7 | <0.001 | |
Ethnicity | White | 111,639 | 92.8 | 10,690 | 87.4 | 100,949 | 93.5 | <0.001 |
Indigenous | 3030 | 2.5 | 717 | 5.9 | 2313 | 2.1 | ||
Other | 5585 | 4.6 | 831 | 6.8 | 4754 | 4.4 | ||
Not stated | 498 | 65 | 433 | |||||
Household income ($ CAD) | 0–29,999 | 44,638 | 43.9 | 8108 | 72.2 | 36,530 | 40.4 | <0.001 |
30,000–49,999 | 25,802 | 25.4 | 1942 | 17.3 | 23,860 | 26.4 | ||
50,000–69,999 | 18,630 | 18.3 | 818 | 7.3 | 17,812 | 19.7 | ||
70,000 + | 12,628 | 12.4 | 367 | 3.2 | 12,261 | 13.5 | ||
Not stated | 19,054 | 1068 | 17,986 | |||||
Education | Less than secondary | 42,199 | 35.3 | 5248 | 43.0 | 36,951 | 34.4 | <0.001 |
Secondary graduate | 26,026 | 21.8 | 2545 | 20.9 | 23,481 | 21.9 | ||
Post-secondary graduate | 51,269 | 42.9 | 4398 | 36.1 | 46,871 | 43.7 | ||
Not stated | 1258 | 112 | 1146 | |||||
Smoking status | Current smoker | 49,309 | 40.8 | 4157 | 33.8 | 45,152 | 41.6 | <0.001 |
Former smoker | 52,395 | 43.4 | 4423 | 36.0 | 47,972 | 44.2 | ||
Never smoker | 19,048 | 15.8 | 3723 | 30.2 | 15,325 | 14.1 | ||
Type of condition | Hypertension | 99,611 | 82.5 | 9962 | 81.0 | 89,649 | 82.7 | <0.001 |
Diabetes | 30,055 | 24.9 | 3821 | 31.1 | 26,234 | 24.2 | <0.001 | |
Heart disease | 32,319 | 26.8 | 3665 | 29.8 | 28,654 | 26.4 | <0.001 | |
Stroke | 6976 | 5.8 | 1054 | 8.6 | 5922 | 5.5 | <0.001 | |
Multimorbidity† | 39,612 | 32.8 | 4852 | 39.4 | 34,760 | 32.1 | <0.001 | |
Mental illness‡ | 12,215 | 12.0 | 2787 | 28.2 | 9428 | 10.3 | <0.001 | |
BMI class (corrected for self-report [35]) | Obese | 39,401 | 37.7 | 4904 | 45.7 | 34,497 | 39,401 | <0.001 |
Overweight | 40,210 | 38.4 | 3468 | 32.3 | 36,742 | 40,210 | ||
Normal/underweight | 24,991 | 23.9 | 2371 | 22.1 | 22,620 | 24,991 | ||
Not stated | 16,150 | 1560 | 14,590 | 16,150 | ||||
Self-perceived health | Excellent/very good | 40,378 | 33.5 | 2194 | 17.9 | 38,184 | 35.3 | <0.001 |
Good | 42,725 | 35.4 | 3664 | 29.9 | 39,061 | 36.1 | ||
Fair/poor | 37,453 | 31.1 | 6416 | 52.2 | 31,037 | 28.7 | ||
Not stated | 196.0 | 29.0 | 167 |
Statistical analysis
Results
Outcome | Adjusted incidence ratea (95% CI) (no. outcomes/year/1000 population) | Incidence rate ratio (95% CI) | |||||
---|---|---|---|---|---|---|---|
No financial barrier | Financial barrier | Crude | Fully adjusted | Reduced final | Final covariates | ||
Home care (only >75 years) |
N (%) | 23,397 (98.8) | 280 (1.2) | ||||
DR-Hosp | 60.2 (58.3-62.2) | 80.6 (59.8-101.5) | 1.43 (1.10-1.88) | 1.36 (1.05-1.76) | 1.34 (1.03-1.74) | Sex, MM | |
Mortality | 59.6 (58.1-61.2) | 76.1 (60.5-91.7) | 1.26 (1.05-1.51) | 1.15 (0.93-1.42) | 1.28 (1.04-1.57) | Sex | |
Medications |
N (%) | 2782 (92.5) | 224 (7.5) | ||||
DR-Hosp | 26.0 (22.6-29.3) | 40.2 (24.4-56.1) | 1.24 (0.82-1.88) | 1.39 (0.92-2.12) | 1.55 (1.02-2.35) | Age, sex | |
Mortality | 14.2 (11.0-17.3) | 6.7 (0.1-13.3) | 0.40 (0.15-1.07) | 0.39 (0.14-1.07) | 0.47 (0.18-1.27) | Age, sex | |
Healthcare provider/test |
N (%) | 101,040 (97.7) | 2383 (2.3) | ||||
DR-Hosp | 35.0 (34.3-35.7) | 43.3 (37.8-48.7) | 0.98 (0.86-1.11) | 1.08 (0.95-1.24) | 1.24 (1.09-1.40) | Age, sex | |
Mortality | 20.8 (20.3-21.3) | 25.3 (21.9-28.7) | 0.83 (0.73-0.95) | 1.09 (0.93-1.26) | 1.22 (1.06-1.39) | Age, sex | |
Healthful food |
N (%) | 97,754 (91.1) | 9506 (8.9) | ||||
DR-Hosp | 35.5 (34.7-36.2) | 59.5 (56.0-63.0) | 1.25 (1.17-1.33) | 1.31 (1.22-1.41) | 1.68 (1.56-1.79) | Age, sex, MM | |
Mortality | 6.6 (6.4-6.8) | 9.3 (8.6-9.9) | 1.08 (1.02-1.14) | 1.32 (1.23-1.42) | 1.41 (1.31-1.51) | Age, sex, MH, SM | |
Health behaviour modification |
N (%) | 18,142 (98.4) | 289 (1.6) | ||||
DR-Hosp | 35.4 (33.8-37.0) | 37.9 (24.1-51.6) | 0.84 (0.58-1.22) | 1.11 (0.77-1.60) | 1.07 (0.74-1.54) | Age, sex | |
Mortality | 18.0 (16.5-19.5) | 15.5 (5.9-25.1) | 0.56 (0.30-1.02) | 0.89 (0.49-1.62) | 0.90 (0.49-1.63) | Age, sex | |
Unmet need due to cost |
N (%) | 70,826 (99.0) | 750 (1.0) | ||||
DR-Hosp | 34.6 (33.8-35.5) | 44.1 (35.0-53.1) | 1.15 (0.93-1.43) | 1.24 (0.97-1.58) | 1.27 (1.03-1.56) | Age, sex, MM | |
Mortality | 23.2 (22.6-23.7) | 21.1 (16.6-25.6) | 0.69 (0.56-0.83) | 0.83 (0.64-1.06) | 0.90 (0.74-1.09) | Age, sex | |
At least 1 financial barrier |
N (%) | 110,123 (91.2) | 12,303 (10.2) | ||||
DR-Hosp | 31.7 (31.1-32.3) | 43.1 (40.9-45.3) | 1.19 (1.13-1.27) | 1.23 (1.16-1.31) | 1.36 (1.29-1.44) | Age, sex, MM | |
Mortality | 7.7 (7.5-7.9) | 9.6 (9.0-10.1) | 1.02 (0.97-1.07) | 1.09 (1.03-1.16) | 1.24 (1.16-1.32) | Age, sex, MH |
Financial barrier | IRR (95% CI) |
---|---|
Home care | 1.33 (1.01–1.77) |
Medications | 1.20 (0.76–1.92) |
MD/test | 1.05 (0.92–1.21) |
Healthful food | 1.34 (1.25–1.43) |
Lifestyle | 0.99 (0.67–1.45) |
Unmet need | 1.11 (0.90–1.37) |
At least 1 financial barrier | 1.16 (1.09–1.23) |