{"title":"Inequalities in Transitions to Home Care: A Longitudinal Analysis of the Canadian Longitudinal Study on Aging","authors":"","doi":"10.1016/j.jamda.2024.105307","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate inequalities in transitions to home care across a broad set of demographic and socioeconomic factors in Canadian middle-aged and older adults.</div></div><div><h3>Design</h3><div>Longitudinal, retrospective cohort study.</div></div><div><h3>Setting and Participants</h3><div>A total of 51,338 community-dwelling adults aged 45+ years, using national data from the Canadian Longitudinal Study on Aging across 3 timepoints from 2011 to 2021.</div></div><div><h3>Methods</h3><div>We analyzed transitions in home care use using multistate Markov models, with home care use and nonuse as transient states, and loss to follow-up as a terminal state. We calculated hazard ratios for transitions between states adjusting for factors related to home care need (ie, functional limitations, chronic conditions) within the following equity strata: income, education, immigration history, sex, gender, rurality, racial background, and tangible social support.</div></div><div><h3>Results</h3><div>Across all timepoints, 5.4% of non–home care users transitioned to home care by the next timepoint and 33.2% of home care users continued to use home care at the next timepoint. Among non–home care users, identifying as a woman, female, white, completing higher levels of education, having higher income, and having less support available was associated with an increased likelihood of transitioning to home care use. Among home care users, higher income was also associated with a greater likelihood to discontinue using home care compared with lower income users. The association between income and home care use was stronger among female individuals.</div></div><div><h3>Conclusions and Implications</h3><div>We found meaningful differences in home care transitions across several equity strata. Individuals with higher income have greater ability to access to private care, creating inequity in access to home care services. Gendered factors such as income and social support have important associations with home care use. Home care planning and policy must address the unique barriers and disadvantages diverse populations face to ensure equitable use of home care and promote healthy aging.</div></div>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2000,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Medical Directors Association","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1525861024007291","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives
To investigate inequalities in transitions to home care across a broad set of demographic and socioeconomic factors in Canadian middle-aged and older adults.
Design
Longitudinal, retrospective cohort study.
Setting and Participants
A total of 51,338 community-dwelling adults aged 45+ years, using national data from the Canadian Longitudinal Study on Aging across 3 timepoints from 2011 to 2021.
Methods
We analyzed transitions in home care use using multistate Markov models, with home care use and nonuse as transient states, and loss to follow-up as a terminal state. We calculated hazard ratios for transitions between states adjusting for factors related to home care need (ie, functional limitations, chronic conditions) within the following equity strata: income, education, immigration history, sex, gender, rurality, racial background, and tangible social support.
Results
Across all timepoints, 5.4% of non–home care users transitioned to home care by the next timepoint and 33.2% of home care users continued to use home care at the next timepoint. Among non–home care users, identifying as a woman, female, white, completing higher levels of education, having higher income, and having less support available was associated with an increased likelihood of transitioning to home care use. Among home care users, higher income was also associated with a greater likelihood to discontinue using home care compared with lower income users. The association between income and home care use was stronger among female individuals.
Conclusions and Implications
We found meaningful differences in home care transitions across several equity strata. Individuals with higher income have greater ability to access to private care, creating inequity in access to home care services. Gendered factors such as income and social support have important associations with home care use. Home care planning and policy must address the unique barriers and disadvantages diverse populations face to ensure equitable use of home care and promote healthy aging.
期刊介绍：
JAMDA, the official journal of AMDA - The Society for Post-Acute and Long-Term Care Medicine, is a leading peer-reviewed publication that offers practical information and research geared towards healthcare professionals in the post-acute and long-term care fields. It is also a valuable resource for policy-makers, organizational leaders, educators, and advocates.
The journal provides essential information for various healthcare professionals such as medical directors, attending physicians, nurses, consultant pharmacists, geriatric psychiatrists, nurse practitioners, physician assistants, physical and occupational therapists, social workers, and others involved in providing, overseeing, and promoting quality
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