High Health Care Utilization and Costs Associated with Lower Socio-economic Status: Results from a Linked Dataset

Objective: The purpose of this paper was to use a linked dataset to compare health care utilization rates and costs between income groups in Saskatoon, Canada. Methods: The Canadian Community Health Survey was linked to hospital, physician and medication data in Saskatoon. Results: Of 3,688 eligible participants, 3,433 agreed to the health survey and data linkage with health records (83.7% overall response). Low-income residents were 27-33% more likely to be hospitalized and 36-45% more likely to receive a medication than middle- and higher-income residents, but were 5-7% less likely to visit a physician over a one-year period. In comparison to middle-income residents, low-income residents had 56% more high users of hospitals, 166% more high users of physicians and 90% more high users of medications. Low-income residents had 34-35% higher health care costs overall than middle- and high-income residents. After multivariate adjustment for increased disease prevalence, low income had a reduced association with high health care utilization. Conclusions: The results demonstrate that residents with lower income are responsible for disproportionate usage of hospitals, physicians and medications; due mainly (but not entirely) to higher disease prevalence.