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Abstract
Objectives Chronic pain (CP) is a poorly recognised and frequently inadequately treated condition affecting one in five adults. Reflecting on sociodemographic disparities as barriers to CP care in Canada was recently established as a federal priority. The objective of this study was to assess sex and gender differences in healthcare utilisation trajectories among workers living with CP.
Design Retrospective cohort study.
Participants This study was conducted using the TorSaDE Cohort which links the 2007–2016 Canadian Community Health Surveys and Quebec administrative databases (longitudinal claims). Among 2955 workers living with CP, the annual number of healthcare contacts was computed during the 3 years after survey completion.
Outcome Group-based trajectory modelling was used to identify subgroups of individuals with similar patterns of healthcare utilisation over time (healthcare utilisation trajectories).
Results Across the study population, three distinct 3-year healthcare utilisation trajectories were found: (1) low healthcare users (59.9%), (2) moderate healthcare users (33.6%) and (3) heavy healthcare users (6.4%). Sex and gender differences were found in the number of distinct trajectories and the stability of the number of healthcare contacts over time. Multivariable analysis revealed that independent of other sociodemographic characteristics and severity of health condition, sex—but not gender—was associated with the heavy healthcare utilisation longitudinal trajectory (with females showing a greater likelihood; OR 2.6, 95% CI 1.6 to 4.1).
Conclusions Our results underline the importance of assessing sex-based disparities in help-seeking behaviours, access to healthcare and resource utilisation among persons living with CP.
- EPIDEMIOLOGY
- Organisation of health services
- Quality in health care
- PAIN MANAGEMENT
- Sexual and gender disorders
- STATISTICS & RESEARCH METHODS
Data availability statement
Data may be obtained from a third party and are not publicly available. TorSaDE Cohort data links Statistics Canada’s Canadian Community Health Survey (CCHS) data and Quebec Health Ministry data that are not publicly available. Access must be granted by the Institut de la statistique du Québec (ISQ) (data holder) and the Commission d’accès à l’information du Québec. Programming codes can be obtained directly from the corresponding author.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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- EPIDEMIOLOGY
- Organisation of health services
- Quality in health care
- PAIN MANAGEMENT
- Sexual and gender disorders
- STATISTICS & RESEARCH METHODS
Data availability statement
Data may be obtained from a third party and are not publicly available. TorSaDE Cohort data links Statistics Canada’s Canadian Community Health Survey (CCHS) data and Quebec Health Ministry data that are not publicly available. Access must be granted by the Institut de la statistique du Québec (ISQ) (data holder) and the Commission d’accès à l’information du Québec. Programming codes can be obtained directly from the corresponding author.
Supplementary materials
Supplementary Data
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Footnotes
Collaborators TorSaDE Cohort Working Group : Past and current members of the TorSaDE Cohort Working Group are as follows: Alain Vanasse (outgoing director), Alexandre Lebel, Amélie Quesnel-Vallée, Anaïs Lacasse (incoming director), André Néron, Anne-Marie Cloutier, Annie Giguère, Benoit Lamarche, Bilkis Vissandjee, Catherine Hudon, Danielle St-Laurent, David Buckeridge, Denis Roy, Geneviève Landry, Gillian Bartlett, Guillaume Blanchet, Hermine Lore Nguena Nguefack, Isabelle Leroux, Jaime Borja, Jean-François Ethier, Josiane Courteau, Lucie Blais, Manon Choinière, Marc Dorais, Marc-André Blanchette, Marc-Antoine Côté-Marcil, Marie-Josée Fleury, Marie-Pascale Pomey, Mike Benigeri, Mireille Courteau, Nadia Sourial, Pasquale Roberge, Pier Tremblay, Pierre Cambon, Roxanne Dault, Sonia Jean, Sonia Quirion, Stéphanie Plante, Thomas Poder, Valérie Émond.
Contributors Each author listed in the manuscript has participated actively and sufficiently in this study to fulfill all authorship criteria of the International Committee of Medical Journal Editors (ICMJE). AL, GP, MC, OMS, JK and NM conceptualised the project and secured funding. AL led the study, wrote the statistical analysis plan and drafted the manuscript. HLNN conducted the statistical analysis and assisted in drafting the manuscript. NM, BV and MZ contributed to the interpretation of data. All authors revised the manuscript critically, gave final approval of the version to be published and agreed to act as guarantors of the work.
Funding This work was supported by the Canadian Institutes of Health Research (CIHR) (Personalised Health Catalyst Grants—Development of predictive analytic models: #PCG155479) and the Fondation de l’Université du Québec en Abitibi-Témiscamingue (FUQAT; no funding #). The implementation of the TorSaDE Cohort was funded by the Quebec SUPPORT Unit (Support for People and Patient-Oriented Research and Trials; no funding #), an initiative funded by the CIHR, the Ministry of Health and Social Services of Québec, and the Fonds de recherche du Québec—Santé (FRQS). During this study, GP and AL were, respectively, Junior 1 and Junior 2 research scholars from the FRQS. JK is supported by a CIHR Research Chair in health psychology. This research received no specific grant from the commercial sector.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.
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