title: Factors associated with hospitalisations for ambulatory care-sensitive conditions among persons with an intellectual disability: a publicly insured population perspective.
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.
authors.affiliation: Dual Diagnosis Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. robert.balogh@utoronto.ca
authors.forename: R S
authors.initials: RS
authors.lastname: Balogh
authors.forename: H
authors.initials: H
authors.lastname: Ouellette-Kuntz
authors.forename: M
authors.initials: M
authors.lastname: Brownell
authors.forename: A
authors.initials: A
authors.lastname: Colantonio
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007198:Indians, North American / Q000706:statistics & numerical data; D008607:Intellectual Disability / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009313:National Health Programs / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult