RT Journal Article
SR Electronic
T1 Social determinants of access to timely elective surgery in Ontario, Canada: a cross-sectional population level study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E1164
OP E1180
DO 10.9778/cmajo.20230001
VO 11
IS 6
A1 de Jager, Pieter
A1 Aleman, Dionne
A1 Baxter, Nancy
A1 Bell, Chaim
A1 Bodur, Merve
A1 Calzavara, Andrew
A1 Campbell, Robert
A1 Carter, Michael
A1 Emerson, Scott
A1 Gagliardi, Anna
A1 Irish, Jonathan
A1 Martin, Danielle
A1 Lee, Samantha
A1 Saxe-Braithwaite, Marcy
A1 Seyedi, Pardis
A1 Takata, Julie
A1 Yang, Suting
A1 Zanchetta, Claudia
A1 Urbach, David
YR 2023
UL http://www.cmajopen.ca/content/11/6/E1164.abstract
AB Background: Equitable access to surgical care has clinical and policy implications. We assess the association between social disadvantage and wait times for elective surgical procedures in Ontario.Methods: We conducted a cross-sectional analysis using administrative data sets of adults receiving nonurgent inguinal hernia repair, cholecystectomy, hip arthroplasty, knee arthroplasty, arthroscopy, benign uterine surgery and cataract surgery from April 2013 to December 2019. We assessed the relation between exceeding target wait times and the highest versus lowest quintile of marginalization dimensions by use of generalized estimating equations logistic regression.Results: Of the 1 385 673 procedures included, 174 633 (12.6%) exceeded the target wait time. Adjusted analysis for cataract surgery found significantly increased odds of exceeding wait times for residential instability (adjusted odd ratio [OR] 1.16, 95% confidence interval [CI] 1.11–1.21) and recent immigration (adjusted OR 1.12, 95% CI 1.07–1.18). The highest deprivation quintile was associated with 18% (adjusted OR 1.18, 95% CI 1.12–1.24) and 20% (adjusted OR 1.20, 95% CI 1.12–1.28) increased odds of exceeding wait times for knee and hip arthroplasty, respectively. Residence in areas where higher proportions of residents self-identify as being part of a visible minority group was independently associated with reduced odds of exceeding target wait times for hip arthroplasty (adjusted OR 0.82, 95% CI 0.75–0.91), cholecystectomy (adjusted OR 0.68, 95% CI 0.59–0.79) and hernia repair (adjusted OR 0.65, 95% CI 0.56–0.77) with an opposite effect in benign uterine surgery (adjusted OR 1.28, 95% CI 1.17–1.40).Interpretation: Social disadvantage had a small and inconsistent impact on receiving care within wait time targets. Future research should consider these differences as they relate to resource distribution and the organization of clinical service delivery.