Health service utilization in immigrants compared to long-term residents with MS in Ontario, Canada
ECTRIMS Online Library. Rotstein D. 09/13/19; 279553; 292
Dalia Rotstein
Dalia Rotstein
Contributions
Abstract

Abstract: 292

Type: Scientific Session

Abstract Category: Clinical aspects of MS - Epidemiology

D. Rotstein1, R.A. Marrie2, K. Tu1, S. Schultz3, K. Fung3, C. Maxwell4

1University of Toronto, Toronto, ON, 2University of Manitoba, Winnipeg, MB, 3Institute of Clinical Evaluative Sciences, Toronto, 4University of Waterloo, Waterloo, ON, Canada

Objectives: To compare health service utilization before, during, and after the MS diagnostic year in immigrants versus long-term residents.
Methods: We identified incident cases of MS among adults aged 20-65 years by applying a validated algorithm to health administrative data in Ontario, Canada, a region with universal health insurance and comprehensive coverage. We assessed rates of health service utilization with respect to hospitalizations, Emergency Department (ED) visits, ambulatory neurology and primary care visits, overall and for MS-specifically. We evaluated the association between immigrant status and rates of health service use with negative binomial regression models, controlling for age, sex, socioeconomic status, MS diagnosis year, comorbidity burden, and urban/rural residence.
Results: From 2003 to 2014, there were 13,028 incident MS cases in Ontario, of whom 1,070 (8.2%) were immigrants. Relative to long-term residents, immigrants were more likely to be hospitalized during the diagnosis year (17.1% vs. 13.7%, p=0.002; adjusted rate ratio (ARR) 1.20, 95% CI: 1.04-1.39), and to have ambulatory neurology visits (91.9% vs 83.8%, p< .001; ARR 1.17, 95% CI: 1.12-1.23), but they had fewer ED visits (ARR 0.86; 95% CI: 0.78-0.96). In the year following diagnosis, immigrants continued to have more ambulatory neurology visits (ARR 1.16; 95% CI: 1.10-1.23), but had fewer hospitalizations (ARR 0.79; 95% CI: 0.67-0.94).
Conclusions: Overall, our findings were reassuring concerning health service access for immigrants with MS in Ontario, a publicly funded health care system. However, immigrants were more likely to be hospitalized in the diagnosis year, despite greater use of ambulatory neurology care. Reasons for this may include more severe disease presentation and/or lack of social support among immigrants and warrant further investigation.
Disclosure: DR receives research support from the MS Society of Canada and Consortium of Multiple Sclerosis Centers. She has served as a speaker or consultant for Biogen, Novartis, Roche, EMD Serono, and Sanofi Aventis.
RAM receives research funding from the Canadian Institutes of Health Research, Multiple Sclerosis Society of Canada, National Multiple Sclerosis Society, Research Manitoba, Consortium of Multiple Sclerosis Centers, Crohn´s and Colitis Canada, and the Waugh Family Chair in Multiple Sclerosis.
CJM has received Research funding from the Canadian Institutes of Health Research, P.S.I Foundation, MS Society of Canada, Consortium of MS Centers, MS Scientific Research Foundation, Ontario Ministry of Health and Long-Term Care Health System Research Fund, Canadian Frailty Network, Partners for Canadian Consortium on Neurodegeneration in Aging, Network for Aging Research-University of Waterloo. She is supported by a University Research Chair at the University of Waterloo.
KT has received research funding from the Department of Defense United States of America, MaRS Innovation Fund, Canadian Institutes of Health Research(CIHR), Rathlyn Foundation, Canadian Initiative for Outcomes in Rheumatology Care, Toronto Rehab Institute Chair Fund, PSI Foundation, University of Toronto Practice-Based Research Network (UTOPIAN), Cancer Care Ontario, Clinical Programs & Quality Initiatives, Arthritis Society, McLaughlin Centre Accelerator Grant, MS Society of Canada, Consortium of MS Centers, Ontario SPOR Support Unit, Ontario Institute for Cancer Research Health Services Research Program, Vascular Network and Heart and Stroke Foundation of Ontario. She also receives a research scholar award from the Department of Family and Community Medicine at the University of Toronto.

Abstract: 292

Type: Scientific Session

Abstract Category: Clinical aspects of MS - Epidemiology

D. Rotstein1, R.A. Marrie2, K. Tu1, S. Schultz3, K. Fung3, C. Maxwell4

1University of Toronto, Toronto, ON, 2University of Manitoba, Winnipeg, MB, 3Institute of Clinical Evaluative Sciences, Toronto, 4University of Waterloo, Waterloo, ON, Canada

Objectives: To compare health service utilization before, during, and after the MS diagnostic year in immigrants versus long-term residents.
Methods: We identified incident cases of MS among adults aged 20-65 years by applying a validated algorithm to health administrative data in Ontario, Canada, a region with universal health insurance and comprehensive coverage. We assessed rates of health service utilization with respect to hospitalizations, Emergency Department (ED) visits, ambulatory neurology and primary care visits, overall and for MS-specifically. We evaluated the association between immigrant status and rates of health service use with negative binomial regression models, controlling for age, sex, socioeconomic status, MS diagnosis year, comorbidity burden, and urban/rural residence.
Results: From 2003 to 2014, there were 13,028 incident MS cases in Ontario, of whom 1,070 (8.2%) were immigrants. Relative to long-term residents, immigrants were more likely to be hospitalized during the diagnosis year (17.1% vs. 13.7%, p=0.002; adjusted rate ratio (ARR) 1.20, 95% CI: 1.04-1.39), and to have ambulatory neurology visits (91.9% vs 83.8%, p< .001; ARR 1.17, 95% CI: 1.12-1.23), but they had fewer ED visits (ARR 0.86; 95% CI: 0.78-0.96). In the year following diagnosis, immigrants continued to have more ambulatory neurology visits (ARR 1.16; 95% CI: 1.10-1.23), but had fewer hospitalizations (ARR 0.79; 95% CI: 0.67-0.94).
Conclusions: Overall, our findings were reassuring concerning health service access for immigrants with MS in Ontario, a publicly funded health care system. However, immigrants were more likely to be hospitalized in the diagnosis year, despite greater use of ambulatory neurology care. Reasons for this may include more severe disease presentation and/or lack of social support among immigrants and warrant further investigation.
Disclosure: DR receives research support from the MS Society of Canada and Consortium of Multiple Sclerosis Centers. She has served as a speaker or consultant for Biogen, Novartis, Roche, EMD Serono, and Sanofi Aventis.
RAM receives research funding from the Canadian Institutes of Health Research, Multiple Sclerosis Society of Canada, National Multiple Sclerosis Society, Research Manitoba, Consortium of Multiple Sclerosis Centers, Crohn´s and Colitis Canada, and the Waugh Family Chair in Multiple Sclerosis.
CJM has received Research funding from the Canadian Institutes of Health Research, P.S.I Foundation, MS Society of Canada, Consortium of MS Centers, MS Scientific Research Foundation, Ontario Ministry of Health and Long-Term Care Health System Research Fund, Canadian Frailty Network, Partners for Canadian Consortium on Neurodegeneration in Aging, Network for Aging Research-University of Waterloo. She is supported by a University Research Chair at the University of Waterloo.
KT has received research funding from the Department of Defense United States of America, MaRS Innovation Fund, Canadian Institutes of Health Research(CIHR), Rathlyn Foundation, Canadian Initiative for Outcomes in Rheumatology Care, Toronto Rehab Institute Chair Fund, PSI Foundation, University of Toronto Practice-Based Research Network (UTOPIAN), Cancer Care Ontario, Clinical Programs & Quality Initiatives, Arthritis Society, McLaughlin Centre Accelerator Grant, MS Society of Canada, Consortium of MS Centers, Ontario SPOR Support Unit, Ontario Institute for Cancer Research Health Services Research Program, Vascular Network and Heart and Stroke Foundation of Ontario. She also receives a research scholar award from the Department of Family and Community Medicine at the University of Toronto.

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