Factors associated with hospitalisations for ambulatory care-sensitive conditions among persons with an intellectual disability: a publicly insured population perspective.
Where adults with ID live — rural or high-First-Nations areas — doubles their odds of preventable hospitalisation.
01Research in Context
What this study did
Chiviacowsky et al. (2013) looked at every adult with intellectual disability covered by public insurance in one Canadian province. They asked: who lands in hospital for problems that good primary care could prevent?
The team mapped each person’s home postal code and checked if it was rural or had many First Nations residents. They then counted preventable hospital stays for things like asthma, diabetes crises, or bad infections.
What they found
Adults with ID who lived in rural or high-First-Nations areas were over twice as likely to be hospitalised for preventable reasons. Geography mattered more than age or sex.
The study shows place-based risk, not just personal health, drives these avoidable admissions.
How this fits with other research
Cooper et al. (2011) found the same pattern in the UK: poorer neighbourhoods meant more emergency visits and fewer planned outpatient visits for adults with ID. Together the two studies make a cross-country case that deprivation plus distance blocks routine care.
Older surveys from Taiwan — Thomas et al. (2004) and Lin et al. (2006) — already showed that multiple handicaps and poor health raise hospital use. The Canadian study widens the lens from individual traits to community factors like rurality.
Hatton et al. (2004) systematic review warned that people with ID have higher rates of epilepsy, skin and sensory problems. The new data say even when the conditions are known, place still predicts whether the person ends up in hospital.
Why it matters
If your caseload includes adults with ID who live far from clinics or on reserves, expect more health crises. Build care plans that travel: tele-health check-ins, mobile nursing, or scheduled van transport to labs. Flag rural clients for proactive monitoring of hydration, skin, breathing and blood sugar so small problems stay small.
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02At a glance
03Original abstract
BACKGROUND: Hospitalisations for ambulatory care-sensitive (ACS) conditions are used as an indicator of access to, and the quality of, primary care. The objective was to identify factors associated with hospitalisations for ACS conditions among adults with an intellectual disability (ID) in the context of a publicly insured healthcare system. METHODS: This study examined adults with an ID living in a Canadian province between 1999 and 2003 identified from administrative databases. Using 5 years of data for the study population, characteristics of persons hospitalised or not hospitalised for ACS conditions were compared. Using a conceptual model, independent variables were selected and an analysis performed to identify which were associated with hospitalisations for ACS conditions. The correlated nature of the observations was accounted for statistically. RESULTS: Living in a rural area [odds ratio (OR) 1.3; 95% confidence intervals (CI) = 1.0, 1.8], living in an area with a high proportion of First Nations people (OR 2.3; 95% CI = 1.3, 4.1), and experiencing higher levels of comorbidity (OR 25.2; 95% CI = 11.9, 53.0) were all associated with a higher likelihood of being hospitalised for an ACS condition. Residing in higher income areas had a protective effect (OR 0.56; 95% CI = 0.37, 0.85). None of the health service resource variables showed statistically significant associations. CONCLUSIONS: Persons with an ID experience inequity in hospitalisations for ACS conditions according to rurality, income and proportion who are First Nations in a geographic area. This suggests that addressing the socio-economic problems of poorer areas and specifically areas densely populated by First Nations people may have an impact on the number of hospitalisations for ACS conditions. Study strengths and limitations and areas for potential future research are discussed.
Journal of intellectual disability research : JIDR, 2013 · doi:10.1111/j.1365-2788.2011.01528.x