Suchergebnisse

Background: Immigrants to Canada are less likely to report depression compared with the non-immigrant population. This healthy migrant effect has not so far been explained by demographic and socioeconomic determinants of health. Aim: The present study examined whether the psychological health advantage of immigrants varied across Canadian health regions and investigated the hypothesis of immigrant density as a determinant of immigrant mental health advantage. Methods: Data from the 2000—2001 Canadian Community Health Survey were used to build multi-level models estimating variation in depression within and between health regions by immigrant/visible minority status. Results: Immigrant and visible minority residents were less likely to experience depression compared with the general population. Depression varied across health regions and the extent of variation was greater for visible minorities. The likelihood of depression decreased with increasing percentage of immigrants in the region among visible minority participants but not among whites. Conclusions: The protection against depression afforded by immigrant and visible minority status in Canada appears to depend on contextual factors, notably the percentage of immigrants in the region. Future work should seek to better characterize the experiences of visible minorities in different settings.

ObjectivesHousehold factors can affect the level and type of health and social care a person with long-term conditions needs. Information on household composition and health needs within households is not easily available in routine health records but linked data from health providers and local government can address this gap.
ApproachIndividual-level linked data from local government services, health providers and health commissioners in Barking and Dagenham was used. This provided sociodemographic, health and household information alongside activity data for five care settings (primary care, hospital, community, inpatient and outpatient mental health services, and social care). We identified 9222 residents aged 50+ living in two-person households between April 2016 and March 2018. Their long-term conditions were counted using primary care data. Annualised use and cost of care services were compared for households with one versus both residents having two or more long-term conditions (known as "multimorbidity").
ResultsOver 45% of multimorbid people in two-person households were co-resident with another multimorbid person. This percentage was higher in the most deprived areas. In households where both residents were multimorbid, each resident had higher use of some types of care. After adjustment for age, gender and area deprivation, those co-resident with another multimorbid person were 1.14 (95% CI 1.00, 1.30) times as likely to have any community care activity and 1.24 (95% CI 0.99,1.54) times as likely to have any mental health care activity compared to those co-resident with a healthy person. They had more primary care visits (8.5 (95% CI 8.2,8.8) vs 7.9 (95% CI 7.7,8.2)) and higher primary care costs. Outpatient care and elective admissions did not differ between these groups.
ConclusionsCare use for people with multimorbidity depends on the health of others in their household. Use of household health data could inform local planning for health and other community services. Its use for delivering individual or household level care could be explored, if acceptable to patients. Future research could examine larger households.

AbstractLittle is known about the patterning of multiple long‐term conditions (MLTCs) by age, ethnicity and across conceptualisations of MLTCs (e.g. MLTCs with/without mental health conditions [MHCs]). We examined ethnic inequalities in age‐related patterns of MLTCs, and combinations of physical and MHCs using the English GP Patient Survey and Clinical Practice Research Datalink. We described the association between MLTCs and age using multilevel regression models adjusting for sex and area‐level deprivation with patients nested within GP practices. Similar analyses were repeated for MLTCs that include MHCs. We observed ethnic inequalities from middle‐age onwards such as older Pakistani, Indian, Black Caribbean and Other ethnic people had increased risk of MLTCs compared to white British people, even after adjusting for area‐level deprivation. Compared to white British people, Gypsy and Irish Travellers had higher levels of MLTCs across the age groups, and Chinese people had lower levels. Pakistani and Bangladeshi people aged 50–74 years were more likely than white people to report MLTCs that included MHCs. We find clear evidence of ethnic inequalities in MLTCs. The lower prevalence of MLTCs that include MHCs among some minoritised ethnic groups may be an underestimation due to underdiagnosis and/or inadequate primary care and requires further scrutiny.

ObjectivesThere is mixed evidence on the influence of number of conditions on inequalities in mortality, we explored the association between number of conditions and deprivation on mortality whilst assessing the difference between working age and older adults. We replicated the analysis in England and Ontario, to provide a cross-jurisdiction comparison.
ApproachWe used individual level-linked data from primary care activity, secondary care and mortality data in England and Ontario. For both jurisdictions, we took a random sample of 600,000 adults from 1 January 2015 and followed them up till 31 December 2019. We used cox proportional hazard to test the influence of deprivation (measured using area-level deprivation in deciles) and number of conditions (measured at baseline and capped at six conditions) on survival. Age and sex were also measured at baseline. Analyses were stratified by working age (18-64 years) and older adults (65+ years) and were repeated for England and Ontario.
ResultsDeprivation gradient in mortality rate was steeper in working age than older adults in both jurisdictions. Number of conditions was associated with increased mortality rate, this was stronger for working age than older adults, in England (working age HR = 1.60, 95% CI 1.56,1.64 and older adults HR= 1.26, 95% CI 1.25,1.27) and Canada (working age HR=1.69, 95% CI 1.66,1.72 and older adults HR= 1.39, 95% CI 1.38,1.40). After accounting for number of conditions, the mortality rate associated with deprivation decreased but remained significant. The interaction between number of conditions and deprivation showed that adults with more conditions have a higher mortality rate and those living in deprived areas also have a higher mortality rate but having more conditions attenuates the deprivation gradient in mortality.
ConclusionNumber of conditions contribute to higher mortality rate and inequalities in morality, this is stronger for working age than older adults in England and Ontario. The fragmented health-care system may be contributing to poorer outcomes, further research should help identify which part of the pathway is driving these inequalities further.

Objective To establish a methodological approach to compare two high-need, high-cost (HNHC) patient personas internationally. Data sources Linked individual-level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. Study design We outline a methodological approach to identify HNHC patient types for international comparisons that reflect complex, priority populations defined by the National Academy of Medicine. We define two patient profiles using accessible patient-level datasets linked across different domains of care—hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, long-term care, home-health care, and outpatient drugs. The personas include a frail older adult with a hip fracture with subsequent hip replacement and an older person with complex multimorbidity, including heart failure and diabetes. We demonstrate their comparability by examining the characteristics and clinical diagnoses captured across countries. Data collection/extraction methods Data collected by ICCONIC partners. Principal findings Across 11 countries, the identification of HNHC patient personas was feasible to examine variations in healthcare utilization, spending, and patient outcomes. The ability of countries to examine linked, individual-level data varied, with the Netherlands, Canada, and Germany able to comprehensively examine care across all seven domains, whereas other countries such as England, Switzerland, and New Zealand were more limited. All countries were able to identify a hip fracture persona and a heart failure persona. Patient characteristics were reassuringly similar across countries. Conclusion Although there are cross-country differences in the availability and structure of data sources, countries had the ability to effectively identify comparable HNHC personas for international study. This work serves as the methodological paper for six accompanying papers examining differences in spending, utilization, and outcomes for these personas across countries.