Disparities in the hospital cost of cardiometabolic diseases among lesbian, gay, and bisexual Canadians: a population-based cohort study using linked data

Abstract

Objectives

Sexual identity has been recognized as a social determinant of health; however, evidence is limited on sexual minority status as a possible contributor to inequalities in cardiometabolic outcomes and the related hospital burden. This study aimed to investigate the association between sexual identity and hospital costs for cardiometabolic diseases among a cohort of Canadians using linked survey and administrative data.

Methods

Data from the 2007–2011 Canadian Community Health Survey were linked to acute-care inpatient records from the 2005/2006–2012/2013 Discharge Abstract Database. Multiple linear regression was used to assess the association between self-reported sexual identity and inpatient resource use for cardiometabolic diseases.

Results

Among the population ages 18–59, 2.1% (95% CI 1.9–2.2) identified as lesbian, gay, or bisexual (LGB). LGB individuals more often reported having diabetes or heart disease compared with heterosexuals. The mean inflation-adjusted cost for cardiometabolic-related hospitalizations was found to be significantly higher among LGB patients (CAD$26,702; 95% CI 26,166–60,365) than among their heterosexual counterparts ($10,137; 95% CI 8,639–11,635), in part a reflection of longer hospital stays (13.6 days versus 5.1 days). Inpatient costs remained 54% (95% CI 8–119) higher among LGB patients after controlling for socio-demographics, health status, and health behaviours.

Conclusion

This study revealed a disproportionate cost for potentially avoidable hospitalizations for cardiometabolic conditions among LGB patients, suggesting important unmet healthcare needs even in the Canadian context of universal coverage.

Résumé

Objectifs

L’identité sexuelle a été reconnue comme un déterminant social de la santé. Cependant, les preuves sont limitées sur le statut de minorité sexuelle en tant que contributeur possible aux inégalités dans les résultats de santé cardiométabolique et le fardeau hospitalier connexe. Cette étude visait à étudier l’association entre l’identité sexuelle et les coûts d’hospitalisation pour les maladies cardiométaboliques parmi une cohorte de Canadiens à l’aide de données couplées d’enquête et administratives.

Méthodes

Les données de l’Enquête sur la santé dans les collectivités canadiennes de 2007 à 2011 ont été reliées aux dossiers des patients hospitalisés en soins de courte durée de la Base de données sur les congés des patients de 2005–2006 à 2012–2013. Des modèles de régression linéaire multiple ont été utilisés pour évaluer l’association entre l’identité sexuelle autodéclarée et l’utilisation des ressources hospitalières pour des maladies cardiométaboliques.

Résultats

Parmi la population âgée de 18 à 59 ans, 2,1 % (IC à 95 % : 1,9–2,2) se sont identifiés comme lesbiennes, gais ou bisexuels (LGB). Les personnes LGB ont plus souvent déclaré vivre avec le diabète ou une maladie cardiaque que les hétérosexuels. Le coût moyen ajusté en fonction de l’inflation pour les hospitalisations liées à la cardiométabolie s’est avéré significativement plus élevé chez les patients LGB (26 702 $ CAN; IC à 95 % : 26 166–60 365) par rapport à leurs homologues hétérosexuels (10 137 $; IC à 95 % : 8 639–11 635), en partie le reflet de séjours hospitaliers plus longs (13,6 jours contre 5,1 jours). Les coûts des patients hospitalisés sont restés 54 % (IC à 95 % : 8–119) plus élevés chez les patients LGB après avoir contrôlé pour les caractéristiques sociodémographiques, l’état de santé et les comportements de santé.

Conclusion

Cette étude a révélé un coût disproportionné pour les hospitalisations potentiellement évitables pour des problèmes cardiométaboliques chez les patients LGB, suggérant d’importants besoins de soins de santé non satisfaits, même dans le contexte canadien de la couverture sanitaire universelle.

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Acknowledgements

The authors wish to thank Rhiannon Thompson-Brown for research assistance with literature reviews. The data analysis was conducted at the New Brunswick Research Data Centre (NB-RDC), which is part of the Canadian Research Data Centre Network. The services and activities provided by the NB-RDC are made possible by the financial or in-kind support of the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, the Canadian Foundation for Innovation, Statistics Canada, and the University of New Brunswick.

Funding

This study received financial support from Diabetes Canada, the New Brunswick Health Research Foundation, the Heart and Stroke Foundation of New Brunswick, and Diabetes Action Canada.

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Correspondence to Neeru Gupta.

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The funders and partners had no role in the study design, data analysis, results interpretation, or decision to submit the manuscript for publication. This study complied with the University of New Brunswick’s Research Ethics Board, which does not require an internal institutional review for research projects using data accessed through the NB-RDC.

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The authors declare that they have no conflict of interest.

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Gupta, N., Sheng, Z. Disparities in the hospital cost of cardiometabolic diseases among lesbian, gay, and bisexual Canadians: a population-based cohort study using linked data. Can J Public Health 111, 417–425 (2020). https://doi.org/10.17269/s41997-020-00296-4

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Keywords

  • Health surveys
  • National hospital discharge surveys
  • Sexual minorities
  • LGB persons
  • Cardiometabolic diseases
  • Social determinants of health
  • Hospital costs

Mots-clés

  • Enquêtes de santé
  • Enquêtes nationales sur les congés des patients
  • Minorités sexuelles
  • Personnes LGB
  • Maladies cardiométaboliques
  • Déterminant social de la santé
  • Coûts d’hospitalisation