Prevalence of intellectual and developmental disabilities among first generation adult newcomers, and the health and health service use of this group: A retrospective cohort study

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Abstract

Background

Attention to research and planning are increasingly being devoted to newcomer health, but the needs of newcomers with disabilities remain largely unknown. This information is difficult to determine since population-level data are rarely available on newcomers or on people with intellectual and developmental disabilities (IDD), although in Ontario, Canada these databases are accessible. This study compared the prevalence of IDD among first generation adult newcomers to adult non-newcomers in Ontario, and assessed how having IDD affected the health profile and health service use of newcomers.

Methods

This population-based retrospective cohort study of adults aged 19–65 in 2010 used linked health and social services administrative data. Prevalence of IDD among newcomers (n = 1,649,633) and non-newcomers (n = 6,880,196) was compared. Among newcomers, those with IDD (n = 2,830) and without IDD (n = 1,646,803) were compared in terms of health conditions, and community and hospital service use.

Results

Prevalence of IDD was lower in newcomers than non-newcomers (171.6 versus 898.3 per 100,000 adults, p<0.0001). Among newcomers, those with IDD were more likely than those without IDD to have comorbid physical health disorders, non-psychotic, psychotic and substance use disorders. Newcomers with IDD were also more likely to have psychiatry visits, and frequent emergency department visits and hospitalizations.

Conclusion

First generation adult newcomers have lower rates of IDD than non-newcomers. How much of this difference is attributable to admission policies that exclude people expected to be high health service users versus how much is attributable to our methodological approach is unknown. Finding more medical and psychiatric comorbidity, and more health service use among newcomers with IDD compared to newcomers without IDD is consistent with patterns observed in adults with IDD more generally. To inform polices that support newcomers with IDD future research should investigate reasons for the prevalence finding, barriers and facilitators to timely health care access, and pathways to care.

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A mediation approach to understanding socio-economic inequalities in maternal health-seeking behaviours in Egypt

Lenka Benova, Oona Campbell, George Ploubidis (2015)

Background The levels and origins of socio-economic inequalities in health-seeking behaviours in Egypt are poorly understood. This paper assesses the levels of health-seeking behaviours related to maternal care (antenatal care [ANC] and facility delivery) and their accumulation during pregnancy and childbirth. Secondly, it explores the mechanisms underlying the association between socio-economic position (SEP) and maternal health-seeking behaviours. Thirdly, it examines the effectiveness of targeting of free public ANC and delivery care. Methods Data from the 2008 Demographic and Health Survey were used to capture two latent constructs of SEP: individual socio-cultural capital and household-level economic capital. These variables were entered into an adjusted mediation model, predicting twelve dimensions of maternal health-seeking; including any ANC, private ANC, first ANC visit in first trimester, regular ANC (four or more visits during pregnancy), facility delivery, and private delivery. ANC and delivery care costs were examined separately by provider type (public or private). Results While 74.2% of women with a birth in the 5-year recall period obtained any ANC and 72.4% delivered in a facility, only 48.8% obtained the complete maternal care package (timely and regular facility-based ANC as well as facility delivery) for their most recent live birth. Both socio-cultural capital and economic capital were independently positively associated with receiving any ANC and delivering in a facility. The strongest direct effect of socio-cultural capital was seen in models predicting private provider use of both ANC and delivery. Despite substantial proportions of women using public providers reporting receipt of free care (ANC: 38%, delivery: 24%), this free-of-charge public care was not effectively targeted to women with lowest economic resources. Conclusions Socio-cultural capital is the primary mechanism leading to inequalities in maternal health-seeking in Egypt. Future studies should therefore examine the objective and perceived quality of care from different types of providers. Improvements in the targeting of free public care could help reduce the existing SEP-based inequalities in maternal care coverage in the short term. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0652-8) contains supplementary material, which is available to authorized users.

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Accuracy of administrative databases in identifying patients with hypertension

Karen Tu, Norman RC Campbell, Zhong-Liang Chen … (2007)

Background Traditionally, the determination of the occurrence of hypertension in patients has relied on costly and time-consuming survey methods that do not allow patients to be followed over time. Objectives To determine the accuracy of using administrative claims data to identify rates of hypertension in a large population living in a single-payer health care system. Methods Various definitions for hypertension using administrative claims databases were compared with 2 other reference standards: (1) data obtained from a random sample of primary care physician offices throughout the province, and (2) self-reported survey data from a national census. Results A case-definition algorithm employing 2 outpatient physician billing claims for hypertension over a 3-year period had a sensitivity of 73% (95% confidence interval [CI] 69%–77%), a specificity of 95% (CI 93%–96%), a positive predictive value of 87% (CI 84%–90%), and a negative predictive value of 88% (CI 86%–90%) for detecting hypertensive adults compared with physician-assigned diagnoses. Compared with self-reported survey data, the algorithm had a sensitivity of 64% (CI 63%–66%), a specificity of 94%(CI 93%–94%), a positive predictive value of 77% (76%–78%), and negative predictive value of 89% (CI 88%–89%). When this algorithm was applied to the entire province of Ontario, the age- and sex-standardized prevalence of hypertension in adults older than 35 years increased from 20% in 1994 to 29% in 2002. Conclusions It is possible to use administrative data to accurately identify from a population sample those patients who have been diagnosed with hypertension. Given that administrative data are already routinely collected, their use is likely to be substantially less expensive compared with serial cross-sectional or cohort studies for surveillance of hypertension occurrence and outcomes over time in a large population.

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Identifying cases of congestive heart failure from administrative data: a validation study using primary care patient records.

Steve Rothwell, Domena Tu, Annette Schultz … (2013)

To determine if using a combination of hospital administrative data and ambulatory care physician billings can accurately identify patients with congestive heart failure (CHF), we tested 9 algorithms for identifying individuals with CHF from administrative data. The validation cohort against which the 9 algorithms were tested combined data from a random sample of adult patients from EMRALD, an electronic medical record database of primary care physicians in Ontario, Canada, and data collected in 2004/05 from a random sample of primary care patients for a study of hypertension. Algorithms were evaluated on sensitivity, specificity, positive predictive value, area under the curve on the ROC graph and the combination of likelihood ratio positive and negative. We found that that one hospital record or one physician billing followed by a second record from either source within one year had the best result, with a sensitivity of 84.8% and a specificity of 97.0%. Population prevalence of CHF can be accurately measured using combined administrative data from hospitalization and ambulatory care.

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Author and article information

Contributors

Anna Durbin:

ORCID: http://orcid.org/0000-0002-8495-1203

Role: ConceptualizationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

James K. H. Jung: Role: Writing – original draftRole: Writing – review & editing

Hannah Chung: Role: Formal analysis

Elizabeth Lin: Role: MethodologyRole: Writing – review & editing

Robert Balogh: Role: MethodologyRole: Writing – review & editing

Yona Lunsky: Role: ConceptualizationRole: VisualizationRole: Writing – review & editing

Sungwoo Lim: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 20 June 2019

Publication date Collection: 2019

Volume: 14

Issue: 6

Electronic Location Identifier: e0215804

Affiliations

[1 ] Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada

[2 ] Department of Psychiatry, University of Toronto, 1 King’s College Cir., Toronto, Ontario, Canada

[3 ] ICES, Toronto, Ontario, Canada

[4 ] Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

[5 ] Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, W., Toronto, Ontario, Canada

[6 ] Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

[7 ] Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada

New York City Department of Health and Mental Hygiene, UNITED STATES

Author notes

Competing Interests: The authors of this manuscript have read the journal's policy and have the following competing interests: This paper is part of the Health Care Access Research and Developmental Disabilities (H-CARDD) Program. No endorsement by the Canadian Institutes of Health Research (CIHR), Ontario Ministry of Health and Long-Term Care (MOHLTC), Ontario Ministry of Community and Social Services (MCSS) or Institute for Clinical Evaluative Sciences (ICES) is intended or should be inferred. Parts of our study material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI) and Cancer Care Ontario (CCO). However, the analyses, conclusions, opinions and statements expressed herein are those of authors, and not necessarily those of CIHI and CCO. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

‡ These authors also contributed equally to this work.

* E-mail: Durbinan@ 123456smh.ca

Author information

Anna Durbin http://orcid.org/0000-0002-8495-1203

Article

Publisher ID: PONE-D-18-15807

DOI: 10.1371/journal.pone.0215804

PMC ID: 6586270

PubMed ID: 31220086

SO-VID: eddfc49b-68f6-484f-bfa5-14b841925590

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 25 May 2018

Date accepted : 9 April 2019

Page count

Figures: 0, Tables: 3, Pages: 15

Funding

Funded by: Canadian Institutes of Health Research (CIHR)

Award ID: Partnerships in Health Systems Improvement grant (PHE #103973)

Award Recipient : Yona Lunsky

This paper was supported by a Partnerships in Health Systems Improvement grant (PHE #103973) from the Canadian Institutes of Health Research (CIHR) using data provided by the Ontario Ministry of Health and Long-Term Care (MOHLTC), and the Ontario Ministry of Community and Social Services (MCSS), to the Institute for Clinical Evaluative Sciences (ICES). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability The dataset from this study is held securely in coded form at the Institute for Clinical Evaluative Sciences (ICES). The authors accessed the data set used for this study in a manner that is different from the manner by which individuals who are external to ICES would access the data set. The authors are affiliated with ICES, either directly or as collaborating agents of ICES, and conducted the study in fulfillment of ICES’ mandate as a prescribed entity under Ontario’s Personal Health Information Protection Act. As a result, the authors were authorized, both legally and contractually, to access the data set in a more granular form than individuals who are external to ICES would be permitted to access the data set. External individuals must apply for access to the minimal data to das@ 123456ices.on.ca through ICES’ Data and Analytic Services ( das@ 123456ices.on.ca ), a division of ICES established specifically to provide data and analytic services to third party researchers. External individuals will also need to request permission from Immigration, Refugees and Citizenship Canada to access to their dataset, which was germane to this research. The data set that approved third party researchers would be permitted to access will be adjusted to ensure the risk of re-identification of any underlying individuals is low. The analytic code is not necessary to replicate the study results because the specific diagnostic codes and definitions of study groups are listed in the appendix, and other necessary details are provided in the methods section. However, third party researchers who wish to replicate the results may still request the analytic code from the authors.

Prevalence of intellectual and developmental disabilities among first generation adult newcomers, and the health and health service use of this group: A retrospective cohort study

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Most cited references 36

A mediation approach to understanding socio-economic inequalities in maternal health-seeking behaviours in Egypt

Accuracy of administrative databases in identifying patients with hypertension

Identifying cases of congestive heart failure from administrative data: a validation study using primary care patient records.

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