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- Title
Rates of Mental Illness and Addiction among High-Cost Users of Medical Services in Ontario.
- Authors
Hensel, Jennifer M.; Taylor, Valerie H.; Kinwah Fung; Vigod, Simone N.; Fung, Kinwah
- Abstract
<bold>Objective: </bold>To quantify the burden of mental illness and addiction among high-costing users of medical services (HCUs) using population-level data from Ontario, and compare to a referent group of nonusers.<bold>Method: </bold>We conducted a population-level cohort study using health administrative data from fiscal year 2011-2012 for all Ontarians with valid health insurance as of April 1, 2011 (N = 10,909,351). Individuals were grouped based on medical costs for hospital, emergency, home, complex continuing, and rehabilitation care in 2011-2012: top 1%, top 2% to 5%, top 6% to 50%, bottom 50%, and a zero-cost nonuser group. The rate of diagnosed psychotic, major mood, and substance use disorders in each group was compared to the zero-cost referent group with adjusted odds ratios (AORs) for age, sex, and socioeconomic status. A sensitivity analysis included anxiety and other disorders.<bold>Results: </bold>Mental illness and addiction rates increased across cost groups affecting 17.0% of the top 1% of users versus 5.7% of the zero-cost group (AOR, 3.70; 95% confidence interval [CI], 3.59 to 3.81). This finding was most pronounced for psychotic disorders (3.7% vs. 0.7%; AOR, 5.07; 95% CI, 4.77 to 5.38) and persisted for mood disorders (10.0% vs. 3.3%; AOR, 3.52; 95% CI, 3.39 to 3.66) and substance use disorders (7.0% vs. 2.3%; AOR, 3.82; 95% CI, 3.66 to 3.99). When anxiety and other disorders were included, the rate of mental illness was 39.3% in the top 1% compared to 21.3% (AOR, 2.39; 95% CI, 2.34 to 2.45).<bold>Conclusions: </bold>A high burden of mental illness and addiction among HCUs warrants its consideration in the design and delivery of services targeting HCUs.
- Subjects
ONTARIO; MENTAL illness; ADDICTIONS; MEDICAL care research; MEDICAL care costs; MEDICAL economics; MENTAL illness treatment; PSYCHIATRIC epidemiology; SUBSTANCE abuse treatment; MEDICAL care cost statistics; LONGITUDINAL method; MEDICAL care; NATIONAL health services; SUBSTANCE abuse; ECONOMICS
- Publication
Canadian Journal of Psychiatry, 2016, Vol 61, Issue 6, p358
- ISSN
0706-7437
- Publication type
journal article
- DOI
10.1177/0706743716644764